Organization
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
Active
Other names
DJJ Piedmont Wilderness
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MIA L RICHARDSON (MEDICAID PROJECT ADMINISTRATOR)
(803) 896-4751
Entity
Organization
Contact information
Practice address
20238 HIGHWAY 72 E, CLINTON, SC 29325-4442
(864) 833-4505
(864) 682-4507
Mailing address
PO BOX 21069, COLUMBIA, SC 29221-1069
(803) 896-4751
(803) 896-8473
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DJJ061
—
SC
Enumeration date
02/08/2007
Last updated
08/22/2020
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