Healthcare Provider Details

I. General information

NPI: 1558409029
Provider Name (Legal Business Name): JUVENILES UPHOLDING MORALS AND PRICIPLES OF SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 BLUFF RD
EASTOVER SC
29044-9265
US

IV. Provider business mailing address

8025 SPRINGBROOK RD
COLUMBIA SC
29223-2575
US

V. Phone/Fax

Practice location:
  • Phone: 803-353-0521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMMY LEE WADE
Title or Position: CEO
Credential:
Phone: 803-865-8851