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General NPI Number Information
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NPI Number | 1104977735
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN CHILDREN'S HOME
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 115 CHILDRENS WAY
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City | DUNCAN
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State | SC
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Zip | 29334-9769
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Country | US
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Telephone | 864-439-0259
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Fax |
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Provider Business Mailing Address
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Address Line | 115 CHILDRENS WAY
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City | DUNCAN
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State | SC
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Zip | 29334-9769
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Country | US
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Telephone | 864-439-0259
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROBERT C. KIMBERLY
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Credential |
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Telephone | 864-439-0259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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