1558409029 NPI number — JUVENILES UPHOLDING MORALS AND PRICIPLES OF SOCIETY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558409029 NPI number — JUVENILES UPHOLDING MORALS AND PRICIPLES OF SOCIETY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUVENILES UPHOLDING MORALS AND PRICIPLES OF SOCIETY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558409029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8025 SPRINGBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29223-2575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8801 BLUFF RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTOVER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29044-9265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-353-0521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WADE
Authorized Official First Name:
SAMMY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
803-865-8851

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MC0070 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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