NPIMap

Organization Active NPI

Carolina Family Services of Greenville LLC

  • Community/Behavioral Health Agency
  • Greenville, SC
National Provider Identifier
1073761870
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CAROLINA FAMILY SERVICES OF GREENVILLE LLC
Practice address
17 Memorial Medical Drive
Greenville, SC 29605-4407
Phone
(864) 283-0637
Fax
(864) 283-0638
NPI assigned
Sep 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jennifer L Brooks, PHD, LPC/S
Title
Ceo
Phone
(864) 283-0637

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

17 Memorial Medical Drive
Greenville, SC 29605-4407

Mailing address

17 Memorial Medical Drive
Greenville, SC 29605-4407
Phone (864) 283-0637

Other identifiers 1

IdentifierTypeStateIssuer
GP4952MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Carolina Family Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1073761870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 MEMORIAL MEDICAL DRIVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054407",
            "telephone_number": "864-283-0637",
            "fax_number": "864-283-0638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 MEMORIAL MEDICAL DRIVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054407",
            "telephone_number": "864-283-0637",
            "fax_number": "864-283-0638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA FAMILY SERVICES OF GREENVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-04",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "864-283-0637",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LPC/S"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4952",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.