MEDICARE: JEWISH FAMILY SERVICES OF GREATER CHARLOTTE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60054	OTHER	NC	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0247W	OTHER	NC	BLUE CROSS/BLUE SHIELD
4	221170000	OTHER	NC	MAGELLAN BEHAVIORAL HEALT

General Provider Information

NPI Number	:	1083691695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH FAMILY SERVICES OF GREATER CHARLOTTE, INC

Provider Business Mailing Address
First Line	:	5007 PROVIDENCE RD
Second Line	:	#105
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-5849
Country	:	US
Telephone Number	:	704-364-6594
Fax Number	:	704-364-6596

Provider Business Practice Location Address
First Line	:	5007 PROVIDENCE RD
Second Line	:	#105
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-5849
Country	:	US
Telephone Number	:	704-364-6594
Fax Number	:	704-364-6596

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JEAN MORGAN
Credential	:
Telephone Number	:	704-364-6594

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	02/03/2021

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