Provider Demographics
NPI:1104579424
Name:EPIC COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:EPIC COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-829-2273
Mailing Address - Street 1:1400 OLD DIXIE HWY
Mailing Address - Street 2:SUITE A.
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4190
Mailing Address - Country:US
Mailing Address - Phone:904-829-2273
Mailing Address - Fax:904-824-0724
Practice Address - Street 1:3574 US HIGHWAY 1 SOUTH
Practice Address - Street 2:SUITES 106-111
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6466
Practice Address - Country:US
Practice Address - Phone:904-829-2273
Practice Address - Fax:904-824-0724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPIC COMMUNITY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070827500Medicaid