Provider Demographics
NPI:1306280441
Name:CHILDREN'S ATTENTION HOME
Entity type:Organization
Organization Name:CHILDREN'S ATTENTION HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANQUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-328-8871
Mailing Address - Street 1:PO BOX 2912
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4912
Mailing Address - Country:US
Mailing Address - Phone:803-328-8871
Mailing Address - Fax:803-324-0437
Practice Address - Street 1:1149 EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4971
Practice Address - Country:US
Practice Address - Phone:803-328-8871
Practice Address - Fax:803-324-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-0001017787001-CCI253J00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency