Organization
360 CASE MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUANETHEA BRYANT-LORD (OWNER)
(803) 226-0236
Entity
Organization
Contact information
Practice address
35 VARDEN DR STE A, AIKEN, SC 29803-5275
(803) 226-0236
(803) 226-0335
Mailing address
35 VARDEN DR STE A, AIKEN, SC 29803-5275
(803) 226-0236
(803) 226-0335
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
163WC0400X
Case Management Registered Nurse
—
—
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
—
—
225700000X
Massage Therapist
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003227886A
—
GA
05
—
003227886B
—
GA
05
—
003230056A
—
GA
05
—
EX1856
—
SC
Enumeration date
02/10/2020
Last updated
03/16/2024
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