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Organization
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
Active
Organization
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
Active
Other names
Camp Sandhills DJJ
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MIA L RICHARDSON (MEDICAID PROJECT ADMINISTRATOR)
(803) 896-4751
Entity
Organization
Contact information
Practice address
2381 CAMPBELL LAKE RD, PATRICK, SC 29584-4016
(843) 921-3000
(843) 921-0937
Mailing address
PO BOX 21069, COLUMBIA, SC 29221-1069
(803) 896-4751
(803) 896-8473
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DJJ047
—
SC
Enumeration date
02/08/2007
Last updated
08/22/2020
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