Healthcare Provider Details

I. General information

NPI: 1306280441
Provider Name (Legal Business Name): CHILDREN'S ATTENTION HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 EDGEMONT ST
ROCK HILL SC
29730-4971
US

IV. Provider business mailing address

PO BOX 2912
ROCK HILL SC
29732-4912
US

V. Phone/Fax

Practice location:
  • Phone: 803-328-8871
  • Fax: 803-324-0437
Mailing address:
  • Phone: 803-328-8871
  • Fax: 803-324-0437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberSR-0001017787001-CCI
License Number StateSC

VIII. Authorized Official

Name: ANQUAN GIST
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 803-328-8871