Organization
SC DEPT OF DISABILITIES & SPECIAL NEEDS
Active
Other names
Conifer II Community Residence
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT WILLIAM BARFIELD (DEPUTY STATE DIRECTOR ADMINISTRATIO)
(803) 898-9743
Entity
Organization
Contact information
Practice address
3440 HARDEN STREET EXTENSION, COLUMBIA, SC 29240-4706
(803) 898-9600
(803) 898-9653
Mailing address
POST OFFICE BOX 4706, 3440 HARDEN STREET EXTENSION, COLUMBIA, SC 29240-4706
(803) 898-9600
(803) 898-9653
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0765NH
—
SC
Enumeration date
12/19/2006
Last updated
08/22/2020
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