Healthcare Provider Details

I. General information

NPI: 1730471665
Provider Name (Legal Business Name): BILLIE HARDEE HOME FOR BOYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 TIMMONSVILLE HWY
DARLINGTON SC
29532-5077
US

IV. Provider business mailing address

PO BOX 617
DARLINGTON SC
29540-0617
US

V. Phone/Fax

Practice location:
  • Phone: 843-393-8600
  • Fax: 843-393-6471
Mailing address:
  • Phone: 843-393-8600
  • Fax: 843-393-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6375
License Number StateSC

VIII. Authorized Official

Name: WAYNE GATES CHAPMAN
Title or Position: CEO
Credential:
Phone: 843-393-8600