Healthcare Provider Details

I. General information

NPI: 1801942511
Provider Name (Legal Business Name): LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 MIKELL LN
COLUMBIA SC
29205-4225
US

IV. Provider business mailing address

PO BOX 12287
RALEIGH NC
27605-2287
US

V. Phone/Fax

Practice location:
  • Phone: 803-782-7165
  • Fax:
Mailing address:
  • Phone: 919-832-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberSR-0008130001 GH
License Number StateSC

VIII. Authorized Official

Name: MR. DWIGHT MURRAY
Title or Position: AR AND CONTRACTS MANAGER
Credential:
Phone: 919-861-2850