| NPI | 1891835799 |
|---|---|
| Other Name | DJJ PIEDMONT WILDERNESS |
| Entity Type | Organization |
| Authorized Contact | MIA L RICHARDSON Medicaid Project Administrator 803-896-4751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-08-22 |