Healthcare Provider Details

I. General information

NPI: 1972805190
Provider Name (Legal Business Name): CARE HOUSE OF THE PEE DEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PATTON DR
FLORENCE SC
29501-6520
US

IV. Provider business mailing address

1500 PATTON DR
FLORENCE SC
29501-6520
US

V. Phone/Fax

Practice location:
  • Phone: 843-629-0236
  • Fax:
Mailing address:
  • Phone: 843-629-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN 171
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5497
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5008
License Number StateSC

VIII. Authorized Official

Name: MEGAN D. B. TEMPLE
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 843-629-0236