Healthcare Provider Details

I. General information

NPI: 1033251228
Provider Name (Legal Business Name): OCONEE COUNTY DISABILITIES & SPECIAL NEEDS BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S COVE RD
SENECA SC
29672-6711
US

IV. Provider business mailing address

116 S COVE RD
SENECA SC
29672-6711
US

V. Phone/Fax

Practice location:
  • Phone: 864-885-6053
  • Fax: 864-885-6058
Mailing address:
  • Phone: 864-885-6053
  • Fax: 864-885-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TYLER REX
Title or Position: ASSIST EXECUTIVE DIR
Credential:
Phone: 864-885-6055