Basic Information
Provider Information | |||||||||
NPI: | 1417023656 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SPECIALIZED ALTERNATIVE FOR FAMILIES AND YOUTH OF SOUTH CAROLINA, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SAFY OF SOUTH CAROLINA - CHARLESTON | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10100 ELIDA RD | ||||||||
Address2: |   | ||||||||
City: | DELPHOS | ||||||||
State: | OH | ||||||||
PostalCode: | 458339056 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4196958010 | ||||||||
FaxNumber: | 4196950004 | ||||||||
Practice Location | |||||||||
Address1: | 4925 LACROSS RD | ||||||||
Address2: | SUITE #111 | ||||||||
City: | N CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294066510 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8435521220 | ||||||||
FaxNumber: | 8435520502 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/28/2006 | ||||||||
LastUpdateDate: | 06/23/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WRIGHT | ||||||||
AuthorizedOfficialFirstName: | CHRISTI | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | STATE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 8037917328 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SPECIALIZED ALTERNATIVE FOR FAMILIES AND YOUTH OF SOUTH CAROLINA, INC. | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X |   |   | N |   | Agencies | Case Management |   | 253J00000X |   |   | N |   | Agencies | Foster Care Agency |   | 261QM0855X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0801X |   |   | N |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.