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General NPI Number Information
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NPI Number | 1790630697
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Entity Type | Organization
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Legal Business Name | PASSIONATE GROVE SAFE HAVEN
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 116 KERSHAW ST
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City | CHERAW
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State | SC
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Zip | 29520-2408
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Country | US
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Telephone | 803-944-7358
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | CHERAW
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State | SC
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Zip | 29520-0126
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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 | PEER SUPPORT SPECIALIST
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Name | TIFFANY PRAYLOW
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Credential |
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Telephone | 803-944-7358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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