Healthcare Provider Details

I. General information

NPI: 1982634721
Provider Name (Legal Business Name): SOUTHEASTERN CHILDREN'S HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CHILDRENS WAY
DUNCAN SC
29334-9769
US

IV. Provider business mailing address

PO BOX 339
DUNCAN SC
29334-0337
US

V. Phone/Fax

Practice location:
  • Phone: 864-493-0259
  • Fax: 864-949-0248
Mailing address:
  • Phone: 864-439-0259
  • Fax: 864-949-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT C. KIMBERLY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 864-439-0291