Provider Demographics
NPI:1699083576
Name:AMICARE OF SOUTH CAROLINA
Entity type:Organization
Organization Name:AMICARE OF SOUTH CAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV
Authorized Official - Phone:864-944-8118
Mailing Address - Street 1:391 WHITE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:TAMASSEE
Mailing Address - State:SC
Mailing Address - Zip Code:29686-2015
Mailing Address - Country:US
Mailing Address - Phone:864-944-9875
Mailing Address - Fax:864-944-6790
Practice Address - Street 1:391 WHITE ROCK RD
Practice Address - Street 2:
Practice Address - City:TAMASSEE
Practice Address - State:SC
Practice Address - Zip Code:29686-2015
Practice Address - Country:US
Practice Address - Phone:864-944-9875
Practice Address - Fax:864-944-6790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-1017120001-CCI322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children