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General NPI Number Information
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NPI Number | 1639045339
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Entity Type | Organization
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Legal Business Name | CHOOCHOOS MIRACLE CORNER CORPORATION
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Dates
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Enumeration Date | 10/11/2025
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 1103 BELLEVIEW ST # 104
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City | COLUMBIA
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State | SC
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Zip | 29201-1871
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Country | US
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Telephone | 803-845-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 2019 DRIFTWOOD DR
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City | COLUMBIA
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State | SC
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Zip | 29210-6703
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Country | US
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Telephone | 803-845-8020
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. CARINE JULES
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Credential | REV. DR, LPN
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Telephone | 803-845-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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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 | 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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