# SOUTH CAROLINA DEPARTMENT OF MENTAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SOUTH CAROLINA DEPARTMENT OF MENTAL HEALTH
- **Other names:** C.M.Tucker,Jr Nursing Care Center Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043365703
- **Legal business name:** SOUTH CAROLINA DEPARTMENT OF MENTAL HEALTH
- **Authorized official:** KIMBERLY BUTTERFLY RUDD M.D. (DIRECTOR OF PROFESSIONAL SERVICES)
- **Authorized official phone:** (803) 737-5301

## Contact information

- **Practice address:** 2200 HARDEN ST., COLUMBIA, SC 29203-7107
- **Practice address phone:** (803) 737-5339
- **Practice address fax:** (803) 737-5436
- **Mailing address:** 2200 HARDEN ST., COLUMBIA, SC 29203-7107
- **Mailing address phone:** (803) 737-5339
- **Mailing address fax:** (803) 737-5436

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 50001783 | SC | — |
| 314000000X | Skilled Nursing Facility | 50-001783 | SC | — |
| 315D00000X | Inpatient Hospice | 50001783 | SC | — |
| 332BN1400X | Nursing Facility Supplies (DME) | 50001783 | SC | — |
| 333600000X | Pharmacy | 50001783 | SC | — |
| 3336L0003X | Long Term Care Pharmacy | 50001783 | SC | Yes |

## Other

- **Enumeration date:** 01/24/2007
- **Last updated:** 10/18/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4212875 | NCPDP | SC |