Kiva Lodge

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

KIVA LODGE

Practice address

200 Claude Bundrick Rd
Blythewood, SC 29016-9420

Phone

(803) 754-5478

NPI assigned

Feb 25, 2010

Organization subpart

Yes

Parent organization

CTHIIAs reported in NPPES

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

Authorized official

Name

Mrs. Ruth Z Tyler

Title

Care Provider

Phone

(803) 754-5478

Specialties & licenses 2

Addresses

Other names 1

• Mental Health of South Carolina Other name

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

{
    "created_epoch": "1267056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267056000000",
    "number": "1366764870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S FIRETOWER CT",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "29016",
            "telephone_number": "803-754-2328",
            "fax_number": "803-754-2328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CLAUDE BUNDRICK RD",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290169420",
            "telephone_number": "803-754-5478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIVA LODGE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CTHII",
        "enumeration_date": "2010-02-25",
        "last_updated": "2010-02-25",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "Z",
        "authorized_official_title_or_position": "CARE  PROVIDER",
        "authorized_official_telephone_number": "803-754-5478",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mental Health of South Carolina",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Alinda Pauline King-Benjamin
• Carolyn Kleffman
• Erin Kuhn, CCC-SLP
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• Tamika Lewis, PH.D., LPC, NCC
• Lexington Health Inc

• Adult Mental Health Clinic/Center in Blythewood, SC
• Providers in Blythewood, SC by specialty
• Adult Mental Health Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 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.