Healthcare Provider Details

I. General information

NPI: 1962915264
Provider Name (Legal Business Name): MIDLANDS HOUSING ALLIANCE INC-TRANSITIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MAIN ST
COLUMBIA SC
29201
US

IV. Provider business mailing address

2025 MAIN ST
COLUMBIA SC
29201-2125
US

V. Phone/Fax

Practice location:
  • Phone: 803-708-4861
  • Fax:
Mailing address:
  • Phone: 803-708-4861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number9598
License Number StateSC

VIII. Authorized Official

Name: KAMEISHA HEPPARD
Title or Position: DIRECTOR OF PROGRAMS
Credential: LMSW
Phone: 803-708-4861