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General NPI Number Information
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NPI Number | 1851349567
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Entity Type | Organization
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Legal Business Name | CAROLINA BOYS HOME INC
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1303 SYCAMORE AVE
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City | COLUMBIA
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State | SC
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Zip | 29203-4252
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Country | US
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Telephone | 803-786-7100
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Fax | 803-333-0033
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Provider Business Mailing Address
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Address Line | PO BOX 3355
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City | COLUMBIA
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State | SC
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Zip | 29230-3355
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Country | US
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Telephone | 803-786-7100
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Fax | 803-333-0033
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JANNIE M NELSON
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Credential |
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Telephone | 803-786-7100
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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 | SR0001731001GH
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License Number State | SC
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