Provider Demographics
NPI:1063594729
Name:EXCHANGE CLUB PARENT/CHILD RESOURCE CENTER
Entity type:Organization
Organization Name:EXCHANGE CLUB PARENT/CHILD RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-747-1339
Mailing Address - Street 1:1092 E MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4837
Mailing Address - Country:US
Mailing Address - Phone:843-747-1339
Mailing Address - Fax:843-529-3212
Practice Address - Street 1:1092 E MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-4837
Practice Address - Country:US
Practice Address - Phone:843-747-1339
Practice Address - Fax:843-529-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management