Organization
SOUTH CAROLINA DEPARTMENT OF MENTAL HEALTH
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
Legal business name
SOUTH CAROLINA DEPARTMENT OF MENTAL HEALTH
Authorized official
KIMBERLY BUTTERFLY RUDD M.D. (DIRECTOR OF PROFESSIONAL SERVICES)
(803) 737-5301
Entity
Organization
Contact information
Practice address
2200 HARDEN ST., COLUMBIA, SC 29203-7107
(803) 737-5339
(803) 737-5436
Mailing address
2200 HARDEN ST., COLUMBIA, SC 29203-7107
(803) 737-5339
(803) 737-5436
Taxonomy
Speciality
Code
Description
License number
State
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
Primary
50001783
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4212875
NCPDP
SC
Enumeration date
01/24/2007
Last updated
10/18/2011
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