Provider Demographics
NPI:1073564027
Name:NORTH BERKELEY FAMILY CARE, LLC
Entity Type:Organization
Organization Name:NORTH BERKELEY FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:HOLLEMAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-567-4000
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:137 CEDAR DR
Mailing Address - City:SAINT STEPHEN
Mailing Address - State:SC
Mailing Address - Zip Code:29479-0280
Mailing Address - Country:US
Mailing Address - Phone:843-567-4000
Mailing Address - Fax:843-567-3000
Practice Address - Street 1:137 CEDAR DR
Practice Address - Street 2:
Practice Address - City:SAINT STEPHEN
Practice Address - State:SC
Practice Address - Zip Code:29479-3371
Practice Address - Country:US
Practice Address - Phone:843-567-4000
Practice Address - Fax:843-567-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17261261QP2300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1982791414OtherNPI# FOR PA-C EMPLOYED
SCGP4402Medicaid
SC1407852791OtherNPI # FOR MD EMPLOYED
SCGP4402Medicaid