| NPI | 1477909018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY ANN KENNEDY Human Service Specialist 1 843-536-6175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2016-05-12 |