# SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DJJ Beaufort Marine Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578603791
- **Authorized official:** MS. MIA L RICHARDSON (MEDICAID PROJECT ADMINISTRATOR)
- **Authorized official phone:** (803) 896-4751

## Contact information

- **Practice address:** 60 HONEYBEE ISLAND RD, SEABROOK, SC 29940-3306
- **Practice address phone:** (843) 846-2127
- **Practice address fax:** (843) 846-4147
- **Mailing address:** P.O. BOX 21069, COLUMBIA, SC 29221-1069
- **Mailing address phone:** (803) 896-4751
- **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:** 02/07/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | DJJ063 | — | SC |