Provider Demographics
NPI:1255640645
Name:EPIPHANY FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:EPIPHANY FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLNER-CATHCART
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:704-536-6853
Mailing Address - Street 1:6900 FARMINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5551
Mailing Address - Country:US
Mailing Address - Phone:704-536-6853
Mailing Address - Fax:704-536-6045
Practice Address - Street 1:102 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4733
Practice Address - Country:US
Practice Address - Phone:704-536-6853
Practice Address - Fax:704-445-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No291U00000XLaboratoriesClinical Medical Laboratory
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303191Medicaid