Organization
PURPOSE-SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATONYA WILLIAMS (EXECUTIVE DIRECTOR ADULT SERVICES)
(864) 313-4530
Entity
Organization
Contact information
Practice address
5321 OLD BUNCOMBE RD, GREENVILLE, SC 29609-0910
(864) 313-4530
Mailing address
5321 OLD BUNCOMBE RD, GREENVILLE, SC 29609-0910
(864) 313-5274
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
883MXH
—
SC
05
—
936MXH
—
SC
Enumeration date
04/01/2009
Last updated
08/22/2024
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