Healthcare Provider Details

I. General information

NPI: 1013105071
Provider Name (Legal Business Name): THE WILEY GROUP OF SC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WOODROW ST
COLUMBIA SC
29205-1233
US

IV. Provider business mailing address

1500 WOODROW ST
COLUMBIA SC
29205-1233
US

V. Phone/Fax

Practice location:
  • Phone: 803-771-9936
  • Fax: 803-771-0386
Mailing address:
  • Phone:
  • Fax: 803-771-0386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number311Z00000X
License Number StateSC

VIII. Authorized Official

Name: FRANKLIN WILEY
Title or Position: ADMINSTRATOR
Credential:
Phone: 803-771-9919