Organization
CAROLINA AUTISM SUPPORTED LIVING SERVICES
Active
Other names
Carolina Autism
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHIL BLEVINS RN (EXECUTIVE DIRECTOR)
(843) 573-1905
Entity
Organization
Contact information
Practice address
4 CARRIAGE LN STE 302, CHARLESTON, SC 29407-6050
(843) 573-1905
(843) 573-1926
Mailing address
4 CARRIAGE LN STE 302, CHARLESTON, SC 29407-6050
(843) 573-1905
(843) 573-1926
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
894MXH
—
SC
05
—
905MXH
—
SC
05
—
EXG302
—
SC
Enumeration date
10/25/2006
Last updated
05/07/2008
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