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General NPI Number Information
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NPI Number | 1821163544
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Entity Type | Organization
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Legal Business Name | GLENN SPRINGS ACADEMY
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 195 BOYS HOME RD
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City | GLENN SPRINGS
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State | SC
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Zip | 29374-2011
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Country | US
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Telephone | 864-583-4367
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Fax | 864-583-2774
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Provider Business Mailing Address
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Address Line | 195 BOYS HOME RD PO BOX 99
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City | PAULINE
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State | SC
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Zip | 29374-2011
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Country | US
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Telephone | 864-583-4367
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Fax | 864-583-2774
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL D. RANEY
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Credential |
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Telephone | 864-583-4367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | SR-0008022001-CCI
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License Number State | SC
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