Provider Demographics
NPI:1083691695
Name:JEWISH FAMILY SERVICES OF GREATER CHARLOTTE, INC
Entity Type:Organization
Organization Name:JEWISH FAMILY SERVICES OF GREATER CHARLOTTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-364-6594
Mailing Address - Street 1:5007 PROVIDENCE RD
Mailing Address - Street 2:#105
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5849
Mailing Address - Country:US
Mailing Address - Phone:704-364-6594
Mailing Address - Fax:704-364-6596
Practice Address - Street 1:5007 PROVIDENCE RD
Practice Address - Street 2:#105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5849
Practice Address - Country:US
Practice Address - Phone:704-364-6594
Practice Address - Fax:704-364-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60054OtherAETNA
NC6005372Medicaid
NC0247WOtherBLUE CROSS/BLUE SHIELD
NC221170000OtherMAGELLAN BEHAVIORAL HEALT
NC6005372Medicaid