Healthcare Provider Details

I. General information

NPI: 1639045339
Provider Name (Legal Business Name): CHOOCHOOS MIRACLE CORNER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1103 BELLEVIEW ST # 104
COLUMBIA SC
29201-1871
US

IV. Provider business mailing address

2019 DRIFTWOOD DR
COLUMBIA SC
29210-6703
US

V. Phone/Fax

Practice location:
  • Phone: 803-845-8020
  • Fax:
Mailing address:
  • Phone: 803-845-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. CARINE JULES
Title or Position: ADMINISTRATOR
Credential: REV. DR, LPN
Phone: 803-845-8020