Provider Demographics
NPI:1164766499
Name:REMBERT AREA COMMUNITY COALITION
Entity Type:Organization
Organization Name:REMBERT AREA COMMUNITY COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:GREGGS
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-420-1255
Mailing Address - Street 1:8455 CAMDEN HWY
Mailing Address - Street 2:POB 186
Mailing Address - City:REMBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29128-8664
Mailing Address - Country:US
Mailing Address - Phone:803-432-2001
Mailing Address - Fax:803-432-2404
Practice Address - Street 1:8455 CAMDEN HWY
Practice Address - Street 2:
Practice Address - City:REMBERT
Practice Address - State:SC
Practice Address - Zip Code:29128-8664
Practice Address - Country:US
Practice Address - Phone:803-432-2001
Practice Address - Fax:803-432-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1191Medicaid