Organization
ADJUTANT GENERAL OF SC
Active
Other names
SC Youth Challenge Academy @ Camp Long
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE FOGLE (DIRECTOR)
(803) 331-6675
Entity
Organization
Contact information
Practice address
5471 LEESBURG RD., EASTOVER, SC 29044-9184
(803) 832-4876
(803) 832-4880
Mailing address
1 NATIONAL GUARD RD, COLUMBIA, SC 29201-4752
(803) 331-6675
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
PR38913
SC
Other
Enumeration date
09/25/2007
Last updated
06/24/2010
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