Carolina Autism Supported Living Services

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

CAROLINA AUTISM SUPPORTED LIVING SERVICES

Practice address

4 Carriage LN Ste 302
Charleston, SC 29407-6050

Phone

(843) 573-1905

Fax

(843) 573-1926

NPI assigned

Oct 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Phil Blevins, RN

Title

Executive Director

Phone

(843) 573-1905

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Carolina Autism Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1043394976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CARRIAGE LN STE 302",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294076050",
            "telephone_number": "843-573-1905",
            "fax_number": "843-573-1926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CARRIAGE LN STE 302",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294076050",
            "telephone_number": "843-573-1905",
            "fax_number": "843-573-1926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA AUTISM SUPPORTED LIVING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "BLEVINS",
        "authorized_official_first_name": "PHIL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "843-573-1905",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "905MXH",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EXG302",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "894MXH",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Autism",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Corey Ryan Carney, MD
• Shelby Allison Carney, APRN
• Anthony Carnicelli, M.D.
• Carol J Manheim
• Carolina Addiction and Psychiatric Treatment Associates
• Carolina Behavioral Specialists, LLC
• Carolina Center for Pain & Rehabilitation
• Carolina Center of Gynecological Oncology PA
• Carolina Chiropractic
• Carolina Coast Behavioral Services, LLC

• Emotionally Disturbed Childrens' Residential Treatment Facility in Charleston, SC
• Providers in Charleston, SC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.