Healthcare Provider Details

I. General information

NPI: 1225375793
Provider Name (Legal Business Name): A TEAM HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 SUNSET BLVD STE. G.
WEST COLUMBIA SC
29169-2403
US

IV. Provider business mailing address

PO BOX 50232
COLUMBIA SC
29250-0232
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-9612
  • Fax: 803-796-9615
Mailing address:
  • Phone: 803-361-5249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number85573
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number85573
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number85573
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number85573
License Number StateSC

VIII. Authorized Official

Name: MRS. URSHULA CANNON
Title or Position: OWNER
Credential:
Phone: 803-361-5249