Provider Demographics
NPI:1326194051
Name:LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Entity Type:Organization
Organization Name:LUTHERAN FAMILY SERVICES IN THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR AND CONTRACTS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-861-2850
Mailing Address - Street 1:PO BOX 12287
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-2287
Mailing Address - Country:US
Mailing Address - Phone:919-832-2620
Mailing Address - Fax:
Practice Address - Street 1:10035 DELEMAR HWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7841
Practice Address - Country:US
Practice Address - Phone:843-873-0295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-0008129001 GH322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC987MXHMedicaid