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Organization

WIDE AWAKE CENTER AND COMMUNITY OUTREACH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CASSANDRA SMITH (DIRECTOR)
(843) 475-5605
Entity
Organization

Contact information

Practice address
6005 CENTER STATION CT, RAVENEL, SC 29470-5681
(843) 475-5605
Mailing address
1640 BERTHA MARIE LN, WADMALAW ISLAND, SC 29487-7188
(843) 475-5605

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
171W00000X
Contractor
171WH0202X
Home Modifications Contractor
174200000X
Meals Provider
174H00000X
Health Educator
177F00000X
Lodging Provider
251B00000X
Case Management Agency
251S00000X
Community/Behavioral Health Agency
251V00000X
Voluntary or Charitable Agency
253Z00000X
In Home Supportive Care Agency
343900000X
Non-emergency Medical Transport (VAN)
3747P1801X
Personal Care Attendant
Primary
374U00000X
Home Health Aide
376J00000X
Homemaker
385H00000X
Respite Care

Other

Enumeration date
07/21/2025
Last updated
07/21/2025
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