1629529698 NPI number — CLARENDON BEHAVIORAL HEALTH

Table of content: (NPI 1629529698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629529698 NPI number — CLARENDON BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARENDON BEHAVIORAL HEALTH
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:
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:
1629529698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 N. CHURCH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANNING
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-435-2121
Provider Business Mailing Address Fax Number:
803-435-8856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 N. CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-435-2121
Provider Business Practice Location Address Fax Number:
803-435-8856
Provider Enumeration Date:
10/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KIRVEN
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERUM CEO
Authorized Official Telephone Number:
803-435-2121

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1730176934 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com