Provider Demographics
NPI:1003093733
Name:EPWORTH CHILDREN'S HOME
Entity Type:Organization
Organization Name:EPWORTH CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TEDDI
Authorized Official - Middle Name:T
Authorized Official - Last Name:GARRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-256-7394
Mailing Address - Street 1:2900 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1359
Mailing Address - Country:US
Mailing Address - Phone:803-212-4793
Mailing Address - Fax:803-212-4287
Practice Address - Street 1:2900 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1359
Practice Address - Country:US
Practice Address - Phone:803-212-4793
Practice Address - Fax:803-212-4287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
No253J00000XAgenciesFoster Care Agency
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2465Medicaid