Provider Demographics
NPI:1427117910
Name:JAMES R. CLARK MEMORIAL SICKLE CELL FOUNDATION
Entity type:Organization
Organization Name:JAMES R. CLARK MEMORIAL SICKLE CELL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HUNNICUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CFRE
Authorized Official - Phone:803-765-9916
Mailing Address - Street 1:1420 GREGG ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3528
Mailing Address - Country:US
Mailing Address - Phone:803-765-9916
Mailing Address - Fax:803-799-6471
Practice Address - Street 1:1420 GREGG ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3528
Practice Address - Country:US
Practice Address - Phone:803-765-9916
Practice Address - Fax:803-799-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMC0008Medicaid