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General NPI Number Information
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NPI Number | 1235592072
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Entity Type | Organization
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Legal Business Name | DODABABY INC
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 1775 COMMISSARY ST
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City | N CHARLESTON
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State | SC
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Zip | 29405-1905
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Country | US
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Telephone | 843-637-3090
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Fax | 843-737-4108
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Provider Business Mailing Address
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Address Line | 1775 COMMISSARY ST
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City | N CHARLESTON
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State | SC
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Zip | 29405-1905
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Country | US
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Telephone | 843-637-3090
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Fax | 843-737-4108
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GLORIA JEAN JOHNSTON
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Credential | ADMINSTARATOR
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Telephone | 843-696-0819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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