Healthcare Provider Details

I. General information

NPI: 1003093733
Provider Name (Legal Business Name): EPWORTH CHILDREN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 MILLWOOD AVE
COLUMBIA SC
29205-1359
US

IV. Provider business mailing address

2900 MILLWOOD AVE
COLUMBIA SC
29205-1359
US

V. Phone/Fax

Practice location:
  • Phone: 803-212-4793
  • Fax: 803-212-4287
Mailing address:
  • Phone: 803-212-4793
  • Fax: 803-212-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. COURTNEY JONES-MURRAY
Title or Position: BILLING & UTILIZATION DIRECTOR
Credential:
Phone: 803-256-7394