Provider Demographics
NPI:1861458382
Name:LOW COUNTRY FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:LOW COUNTRY FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTLAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-209-5529
Mailing Address - Street 1:POST OFFICE BOX 912
Mailing Address - Street 2:
Mailing Address - City:VARNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29944
Mailing Address - Country:US
Mailing Address - Phone:803-943-1099
Mailing Address - Fax:803-943-2083
Practice Address - Street 1:61 HICKORY HILL ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944
Practice Address - Country:US
Practice Address - Phone:803-943-1099
Practice Address - Fax:803-943-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2014-04-08
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2014-04-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0235Medicaid
SCEX0747Medicaid