NPI 1083755615

South Carolina Department of Juvenile Justice

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Columbia, SC

Practice location

Address: 1600 Shivers Rd, Columbia, SC 29210-5429
Phone: (803) 896-9122
Fax: (803) 896-8476
Mailing address: PO Box 21069, Columbia, SC 29221-1069

Authorised official

Name: Mia L Richardson
Title: Medicaid Project Administrator
Phone: (803) 896-4751

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X

Other Residential Treatment Facility, Emotionally Disturbed Children providers in South Carolina →

Registry record

NPI: 1083755615
Entity type: Organization
NPI issued: 8 Feb 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.