Organization
KIVA LODGE
Active
Organization
KIVA LODGE
Active
Parent organization
CTHII
Other names
Mental Health of South Carolina
Organization subpart
Yes
Provider details
NPI number
Legal business name
CTHII
Authorized official
MRS. RUTH Z TYLER (CARE PROVIDER)
(803) 754-5478
Entity
Organization
Contact information
Practice address
200 CLAUDE BUNDRICK RD, BLYTHEWOOD, SC 29016-9420
(803) 754-5478
Mailing address
11 S FIRETOWER CT, BLYTHEWOOD, SC 29016
(803) 754-2328
(803) 754-2328
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/25/2010
Last updated
02/25/2010
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