Southeastern Children'S Home, Inc.

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

LPC 1810 Issued in SC

Legal business name

SOUTHEASTERN CHILDREN'S HOME, INC.

Practice address

115 Childrens Way
Duncan, SC 29334-9769

Phone

(864) 439-0259

Fax

(864) 949-0248

NPI assigned

Aug 10, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Robert C. Kimberly

Title

Executive Director

Phone

(864) 439-0259

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Southeastern Children'S Home Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Southeastern Children'S Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Duncan, SC
  • NPI 1104977735
  NPD tax ID
• Southeastern Children'S Home, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Duncan, SC
  • NPI 1982634721
  NPD tax ID

Locations

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

{
    "created_epoch": "1281398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1275848640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 CHILDRENS WAY",
            "city": "DUNCAN",
            "state": "SC",
            "postal_code": "293349769",
            "telephone_number": "864-439-0259",
            "fax_number": "864-949-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CHILDRENS WAY",
            "city": "DUNCAN",
            "state": "SC",
            "postal_code": "293349769",
            "telephone_number": "864-439-0259",
            "fax_number": "864-949-0248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN CHILDREN'S HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-10",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "KIMBERLY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "864-439-0259",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "SC",
            "license": "LPC 1810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104977735",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982634721",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Kirkland Smith, MSW
• Joanna Smith, FNP-BC
• Tracy Y Smith
• South Carolina Podiatric Physicians and Surgeons Group, LLC
• Southeastern Children'S Home
• Southeastern Children'S Home, Inc.
• Alexis Sparks
• Spartanburg County School District No. 5
• Spartanburg Medical Center
• Spartanburg Medical Center

• Voluntary or Charitable Agency in Duncan, SC
• Providers in Duncan, SC by specialty
• Voluntary or Charitable Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; 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.