Organization
LUCILLE MANOR COMMUNITY RESIDENTIAL CARE, LLP
Active
Organization
LUCILLE MANOR COMMUNITY RESIDENTIAL CARE, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE MACK MINTZ CRCF (ADMINISTRATOR)
(803) 546-0298
Entity
Organization
Contact information
Practice address
1004 R L COWARD RD, EASTOVER, SC 29044-9455
(803) 546-0298
Mailing address
27 CARRIAGE OAKS CT, COLUMBIA, SC 29229-9300
(803) 546-0298
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/05/2019
Last updated
03/05/2019
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