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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