Provider Demographics
NPI:1013379569
Name:EPIPHANY FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:EPIPHANY FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:704-236-4067
Mailing Address - Street 1:423 N GRANARD ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2345
Mailing Address - Country:US
Mailing Address - Phone:704-236-4067
Mailing Address - Fax:803-324-0208
Practice Address - Street 1:454 ANDERSON RD S
Practice Address - Street 2:SUITE 162
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3392
Practice Address - Country:US
Practice Address - Phone:704-236-4067
Practice Address - Fax:803-324-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC120BHSMedicaid