Healthcare Provider Details

I. General information

NPI: 1104838192
Provider Name (Legal Business Name): SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2461 SIDNEYS RD
WALTERBORO SC
29488-6783
US

IV. Provider business mailing address

PO BOX 485
COLUMBIA SC
29202-0485
US

V. Phone/Fax

Practice location:
  • Phone: 843-538-3000
  • Fax:
Mailing address:
  • Phone: 803-898-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF921
License Number StateSC

VIII. Authorized Official

Name: VERSIE BELLAMY
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 803-935-5761