South Carolina Department of Juvenile Justice
NPI #1629119318 in Fountain Inn, South Carolina
Provider Information
- NPI Number
- 1629119318
- Entity Type
- Organization
- Organization Name
- South Carolina Department of Juvenile Justice
- Primary Specialty
- Residential Treatment Facility, Emotionally Disturbed Children
- Enumeration Date
- Feb 8, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 810 DUNKLIN BRIDGE ROAD
- City
- Fountain Inn
- State
- South Carolina
- ZIP Code
- 29644
- Phone
- (864) 243-5557
Authorized Official
- Name
- MS. MIA L RICHARDSON
- Title
- MEDICAID PROJECT ADMINISTATOR
- Phone
- (803) 896-4751
Specialties & Taxonomy Codes
| Specialty |
|---|
| Residential Treatment Facility, Emotionally Disturbed Children |
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