MEDICARE: SC DEPARTMENT OF JUVENILE JUSTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114271046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SC DEPARTMENT OF JUVENILE JUSTICE

Provider Business Mailing Address
First Line	:	PO BOX 21069
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29221-1069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 W MAIN ST
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2503
Country	:	US
Telephone Number	:	803-359-5526
Fax Number	:

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	MARGARET BARBER
Credential	:
Telephone Number	:	803-896-5940

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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Directions to “SC DEPARTMENT OF JUVENILE JUSTICE ” Practice Location

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