Healthcare Provider Details

I. General information

NPI: 1588823900
Provider Name (Legal Business Name): SOUTH CAROLINA MENTOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FOREST DRIVE SUITE 100
COLUMBIA SC
29204
US

IV. Provider business mailing address

3600 FOREST DRIVE SUITE 100
COLUMBIA SC
29204
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-9025
  • Fax: 803-931-8961
Mailing address:
  • Phone: 803-799-9025
  • Fax: 803-931-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ELAINE MILLER
Title or Position: STATE DIRECTOR
Credential:
Phone: 803-799-9025