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General NPI Number Information
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NPI Number | 1043394976
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Entity Type | Organization
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Legal Business Name | CAROLINA AUTISM SUPPORTED LIVING SERVICES
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 4 CARRIAGE LN STE 302
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City | CHARLESTON
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State | SC
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Zip | 29407-6050
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Country | US
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Telephone | 843-573-1905
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Fax | 843-573-1926
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Provider Business Mailing Address
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Address Line | 4 CARRIAGE LN STE 302
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City | CHARLESTON
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State | SC
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Zip | 29407-6050
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Country | US
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Telephone | 843-573-1905
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Fax | 843-573-1926
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. PHIL BLEVINS
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Credential | RN
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Telephone | 843-573-1905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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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 | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | SC
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