Provider Demographics
NPI:1487067583
Name:COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF SC LLC
Entity type:Organization
Organization Name:COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF SC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:TITO
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-423-2277
Mailing Address - Street 1:1514 CLEVELAND AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6965
Mailing Address - Country:US
Mailing Address - Phone:919-423-2277
Mailing Address - Fax:
Practice Address - Street 1:213 E BUTLER RD
Practice Address - Street 2:SUITE K
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2171
Practice Address - Country:US
Practice Address - Phone:919-423-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health