Organization
WINDWOOD FARM HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH MCKELVEY (EXECUTIVE DIRECTOR)
(843) 884-5342
Entity
Organization
Contact information
Practice address
4857 WINDWOOD FARM RD, AWENDAW, SC 29429-5951
(843) 884-5342
(843) 884-1287
Mailing address
4857 WINDWOOD FARM RD, AWENDAW, SC 29429-5951
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
SR-0008106001-CCI
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4441
—
SC
Enumeration date
07/22/2006
Last updated
08/22/2020
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