Provider Demographics
NPI:1124109699
Name:BIG BROTHERS BIG SISTERS OF GR. COLUMBIA
Entity type:Organization
Organization Name:BIG BROTHERS BIG SISTERS OF GR. COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-691-5700
Mailing Address - Street 1:4300 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5950
Mailing Address - Country:US
Mailing Address - Phone:803-691-5700
Mailing Address - Fax:803-691-5701
Practice Address - Street 1:4300 NORTH MAIN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5950
Practice Address - Country:US
Practice Address - Phone:803-691-5700
Practice Address - Fax:803-691-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMC0028OtherSC MEDICAID PROVIDER NO.