Healthcare Provider Details

I. General information

NPI: 1609219906
Provider Name (Legal Business Name): BILLIE HARDEE HOME FOR BOYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 TIMMONSVILLE HWY
DARLINGTON SC
29532-9998
US

IV. Provider business mailing address

1120 TIMMONSVILLE HWY
DARLINGTON SC
29532-9998
US

V. Phone/Fax

Practice location:
  • Phone: 843-393-8600
  • Fax: 843-393-6471
Mailing address:
  • Phone: 843-393-8600
  • Fax: 843-393-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number9775
License Number StateSC

VIII. Authorized Official

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