MEDICARE: FAMILY PRESERVATION COMMUNITY SERVICES

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	253J00000X	Foster Care Agency
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790736361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRESERVATION COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	3710 LANDMARK DR
Second Line	:	SUITE 307
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4062
Country	:	US
Telephone Number	:	803-782-3422
Fax Number	:	803-782-3426

Provider Business Practice Location Address
First Line	:	3710 LANDMARK DR
Second Line	:	SUITE 307
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4062
Country	:	US
Telephone Number	:	803-782-3422
Fax Number	:	803-782-3426

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS CATHY FREEMAN
Credential	:
Telephone Number	:	803-782-3422

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/12/2016

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Directions to “FAMILY PRESERVATION COMMUNITY SERVICES ” Practice Location

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