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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