Healthcare Provider Details

I. General information

NPI: 1831463538
Provider Name (Legal Business Name): BABCOCK CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 BANNY JONES AVE
WEST COLUMBIA SC
29170-2109
US

IV. Provider business mailing address

PO BOX 4389
WEST COLUMBIA SC
29171-4389
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-1970
  • Fax: 803-799-3418
Mailing address:
  • Phone: 803-799-1970
  • Fax: 803-799-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateSC

VIII. Authorized Official

Name: DR. JUDITH E. JOHNSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 803-799-1970