Individual

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

5322 Issued in SC

Legal business name

INDIVIDUAL

Practice address

1725 Shivers Rd
Columbia, SC 29210-5413

Phone

(803) 896-5732

Fax

(803) 896-5723

NPI assigned

Dec 14, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Jan Giesen, LISW

Title

Director of Social Work

Phone

(803) 896-4813

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1355443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355443200000",
    "number": "1639415920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 SHIVERS RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292105413",
            "telephone_number": "803-896-5732",
            "fax_number": "803-896-5723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 SHIVERS RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292105413",
            "telephone_number": "803-896-5732",
            "fax_number": "803-896-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIVIDUAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-14",
        "last_updated": "2012-12-14",
        "status": "A",
        "authorized_official_last_name": "GIESEN",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "DIRECTOR OF SOCIAL WORK",
        "authorized_official_telephone_number": "803-896-4813",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "SC",
            "license": "5322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Columbia, 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 Dec 14, 2012; 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.