Lucille Manor Community Residential Care, LLP

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

LUCILLE MANOR COMMUNITY RESIDENTIAL CARE, LLP

Practice address

1004 R L Coward Rd
Eastover, SC 29044-9455

Phone

(803) 546-0298

NPI assigned

Mar 5, 2019

Organization subpart

No

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

Authorized official

Name

Jacqueline Mack Mintz, CRCF

Title

Administrator

Phone

(803) 546-0298

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551744000000",
    "number": "1124586599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 CARRIAGE OAKS CT",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292299300",
            "telephone_number": "803-546-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 R L COWARD RD",
            "city": "EASTOVER",
            "state": "SC",
            "postal_code": "290449455",
            "telephone_number": "803-546-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCILLE MANOR COMMUNITY RESIDENTIAL CARE, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-05",
        "last_updated": "2019-03-05",
        "status": "A",
        "authorized_official_last_name": "MINTZ",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "MACK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-546-0298",
        "authorized_official_credential": "CRCF"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; 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.