Provider Demographics
NPI:1790736361
Name:FAMILY PRESERVATION COMMUNITY SERVICES
Entity Type:Organization
Organization Name:FAMILY PRESERVATION COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-782-3422
Mailing Address - Street 1:3710 LANDMARK DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4062
Mailing Address - Country:US
Mailing Address - Phone:803-782-3422
Mailing Address - Fax:803-782-3426
Practice Address - Street 1:3710 LANDMARK DR
Practice Address - Street 2:SUITE 307
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4062
Practice Address - Country:US
Practice Address - Phone:803-782-3422
Practice Address - Fax:803-782-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No253J00000XAgenciesFoster Care AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC916MXHMedicaid
SCCBT009Medicaid