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General NPI Number Information
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NPI Number | 1023617941
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Entity Type | Organization
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Legal Business Name | THE PLACE OF HEALING
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 11/11/2020
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Provider Practice Location Address
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Address Line | 712 PEARL ST
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City | DARLINGTON
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State | SC
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Zip | 29532-3842
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Country | US
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Telephone | 843-944-5080
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Fax | 843-944-5080
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Provider Business Mailing Address
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Address Line | PO BOX 443
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City | DARLINGTON
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State | SC
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Zip | 29540-0443
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Country | US
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Telephone | 843-944-5080
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Fax | 843-944-5080
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DEANDRA NICOLE KETTER
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Credential |
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Telephone | 843-616-6072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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