Provider Demographics
NPI:1740611474
Name:GILL REYNOLDS-PRIDGETT
Entity Type:Organization
Organization Name:GILL REYNOLDS-PRIDGETT
Other - Org Name:CHASE FARMS GROUP CRISIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILL
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS-PRIDGETT
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:1866-559-5735
Mailing Address - Street 1:1320 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3204
Mailing Address - Country:US
Mailing Address - Phone:866-559-5735
Mailing Address - Fax:866-558-2242
Practice Address - Street 1:12 PERIMETER PARK S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2326
Practice Address - Country:US
Practice Address - Phone:866-559-5735
Practice Address - Fax:866-558-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty