# CAROLINA AUTISM SUPPORTED LIVING SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Carolina Autism
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043394976
- **Authorized official:** MR. PHIL BLEVINS RN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (843) 573-1905

## Contact information

- **Practice address:** 4 CARRIAGE LN STE 302, CHARLESTON, SC 29407-6050
- **Practice address phone:** (843) 573-1905
- **Practice address fax:** (843) 573-1926
- **Mailing address:** 4 CARRIAGE LN STE 302, CHARLESTON, SC 29407-6050
- **Mailing address phone:** (843) 573-1905
- **Mailing address fax:** (843) 573-1926

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | — |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | SC | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 05/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 894MXH | — | SC |
| 05 | — | 905MXH | — | SC |
| 05 | — | EXG302 | — | SC |