Healthcare Provider Details

I. General information

NPI: 1912970674
Provider Name (Legal Business Name): ANDERSON SCHOOL DISTRICT FIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PEARMAN DAIRY RD
ANDERSON SC
29625-3100
US

IV. Provider business mailing address

400 PEARMAN DAIRY RD
ANDERSON SC
29625-3100
US

V. Phone/Fax

Practice location:
  • Phone: 864-260-5000
  • Fax:
Mailing address:
  • Phone: 864-260-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID C HENDRICKS
Title or Position: MEDICAID COMPLIANCE COORDINATOR
Credential:
Phone: 864-260-5053