# SOUTH CAROLINA DEPPARTMENT OF JUVENILE JUSTICE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Camp White PinesII
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053451948
- **Authorized official:** MS. MIA L RICHARDSON (MEDICAID PROJECT ADMINISTRATOR)
- **Authorized official phone:** (803) 896-4751

## Contact information

- **Practice address:** 742 T BISHOP RD, JONESVILLE, SC 29353-2342
- **Practice address phone:** (864) 674-0458
- **Practice address fax:** (864) 674-0460
- **Mailing address:** P.O. BOX 21069, COLUMBIA, SC 29221-1069
- **Mailing address phone:** (803) 869-4751
- **Mailing address fax:** (803) 896-8473

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 02/08/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | DJJ062 | — | SC |