Provider Demographics
NPI:1104252584
Name:ANDERSON SCHOOL DISTRICT FOUR
Entity type:Organization
Organization Name:ANDERSON SCHOOL DISTRICT FOUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-403-2000
Mailing Address - Street 1:315 E QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-1721
Mailing Address - Country:US
Mailing Address - Phone:864-403-2000
Mailing Address - Fax:864-403-2099
Practice Address - Street 1:7324 HIGHWAY 187
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-6911
Practice Address - Country:US
Practice Address - Phone:864-403-2100
Practice Address - Fax:864-646-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC213023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSD0404Medicaid