Healthcare Provider Details

I. General information

NPI: 1023832821
Provider Name (Legal Business Name): SOUTH CAROLINA MENTOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SAINT JULIAN PL
COLUMBIA SC
29204-2417
US

IV. Provider business mailing address

6600 FRANCE AVE S STE 350
EDINA MN
55435-1810
US

V. Phone/Fax

Practice location:
  • Phone: 800-388-5150
  • Fax:
Mailing address:
  • Phone: 800-388-5150
  • Fax: 952-922-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY PATRICIA RODENBERG-ROBERTS
Title or Position: VICE PRES & SR ASST GENERAL COUNSEL
Credential:
Phone: 952-836-2234