Healthcare Provider Details

I. General information

NPI: 1790736361
Provider Name (Legal Business Name): FAMILY PRESERVATION COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 LANDMARK DR SUITE 307
COLUMBIA SC
29204-4062
US

IV. Provider business mailing address

3710 LANDMARK DR SUITE 307
COLUMBIA SC
29204-4062
US

V. Phone/Fax

Practice location:
  • Phone: 803-782-3422
  • Fax: 803-782-3426
Mailing address:
  • Phone: 803-782-3422
  • Fax: 803-782-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS CATHY FREEMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-782-3422