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Organization
TRANSITIONS OF GOLDEN SHIELDS LLC
Active
Organization
TRANSITIONS OF GOLDEN SHIELDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNIE C HARDY MPA (CHIEF EXECUTIVE OFFICER)
(802) 250-1282
Entity
Organization
Contact information
Practice address
85 WADING BIRD LOOP, BLYTHEWOOD, SC 29016-5906
(802) 250-1282
(800) 781-1997
Mailing address
PO BOX 188, BLYTHEWOOD, SC 29016-0188
(803) 250-1282
(800) 781-1997
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
NULL
177F00000X
Lodging Provider
—
NULL
251B00000X
Case Management Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
261QC1500X
Community Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NULL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
NULL
Other
Enumeration date
05/06/2019
Last updated
05/06/2019
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