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General NPI Number Information
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NPI Number | 1740103373
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Entity Type | Organization
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Legal Business Name | FIRST FRUIT RESIDENTIAL GROUP HOME III, LLC
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 1151 LIBERTY RD
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City | CHESTER
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State | SC
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Zip | 29706-6939
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Country | US
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Telephone | 704-674-4898
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 LIBERTY RD
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City | CHESTER
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State | SC
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Zip | 29706-6939
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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 | DIRECTOR
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Name | MRS. ATTIYYA SHEEREEN CLEAVES
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Credential |
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Telephone | 704-674-4898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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