NPIMap

Organization Active NPI

South Carolina Department of Juvenile Justice

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Georgetown, SC
National Provider Identifier
1871633081
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
Practice address
1590 East CCC Road
Highway 17 South
Georgetown, SC 29440
Phone
(864) 546-5478
Fax
(843) 546-5652
NPI assigned
Feb 7, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Mia L Richardson
Title
Medicaid Project Administrator
Phone
(803) 896-4751

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

1590 East CCC Road
Highway 17 South
Georgetown, SC 29440

Mailing address

PO Box 21069
Columbia, SC 29221-1069
Phone (803) 896-4751

Other identifiers 1

IdentifierTypeStateIssuer
DJJ057MedicaidSC

Other names 1

  • DJJ Georgetown Marine Inst Other name

National Provider Directory

National Provider Directory
Tax ID family
South Carolina Department of Juvenile Justice280 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1590 E CCC Rd
Georgetown, SC 29440
Phone (864) 546-5478

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871633081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21069",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292211069",
            "telephone_number": "803-896-4751",
            "fax_number": "803-896-8473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 EAST CCC ROAD",
            "address_2": "HIGHWAY 17 SOUTH",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "29440",
            "telephone_number": "864-546-5478",
            "fax_number": "843-546-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "MIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEDICAID PROJECT ADMINISTRATOR",
        "authorized_official_telephone_number": "803-896-4751",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DJJ057",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DJJ Georgetown Marine Inst",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Georgetown, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.