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General NPI Number Information
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NPI Number | 1497290852
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Entity Type | Organization
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Legal Business Name | CAROLINA ROSES OF BLYTHEWOOD LLC
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 300 LONG POINTE LN STE 220-T
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City | COLUMBIA
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State | SC
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Zip | 29229-7543
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Country | US
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Telephone | 803-397-1937
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Fax | 803-735-8112
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Provider Business Mailing Address
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Address Line | PO BOX 942
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City | ELGIN
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State | SC
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Zip | 29045-0942
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SABREEN JOHNSON
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Credential |
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Telephone | 803-397-1937
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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 | 123598
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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