Provider Demographics
NPI:1659457901
Name:COMMUNITIES IN SCHOOLS KERSHAW COUNTY
Entity Type:Organization
Organization Name:COMMUNITIES IN SCHOOLS KERSHAW COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-432-1109
Mailing Address - Street 1:905 WEST DEKALB STREET
Mailing Address - Street 2:SUITE A & F
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-9998
Mailing Address - Country:US
Mailing Address - Phone:803-432-1109
Mailing Address - Fax:803-424-0020
Practice Address - Street 1:905 WEST DEKALB STREET
Practice Address - Street 2:SUITE A & F
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-9998
Practice Address - Country:US
Practice Address - Phone:803-432-1109
Practice Address - Fax:803-424-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMC0052Medicaid
SC2610QF0050XMedicaid