South Carolina Department of Juvenile Justice
South Carolina Department of Juvenile Justice is an Emotionally Disturbed Childrens' Residential Treatment Facility in Fountain Inn, South Carolina. Registered with an NPI since 2007.
- In the registry since
- 2007
Practice location Address checks out
810 Dunklin Bridge RdFountain Inn, SC 29644
Phone: (864) 243-5557
Fax: (864) 243-3339
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Emotionally Disturbed Childrens' Residential Treatment Facility (primary) | Taxonomy 322D00000X |
|---|
Record details
| NPI number | 1629119318 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Mia Richardson — Medicaid Project Administator · (803) 896-4751 |
| Other names | Generations Moderate Management |
| NPI enumerated | February 8, 2007 |
| Last updated in NPPES | August 22, 2020 |
| Mailing address | Po Box 21069, Columbia, SC 29221-1069 |
Other providers in Fountain Inn
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South Carolina Department of Juvenile Justice
810 Dunklin Bridge Rd, Fountain Inn, SC 29644 · (864) 243-5557