Provider Demographics
NPI:1225080260
Name:SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE
Entity Type:Organization
Organization Name:SOUTH CAROLINA DEPT OF MENTAL HEALTH ACCOUNTING OFFICE
Other - Org Name:C M TUCKER JR NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-935-5761
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0485
Mailing Address - Country:US
Mailing Address - Phone:803-898-8405
Mailing Address - Fax:
Practice Address - Street 1:2200 HARDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7107
Practice Address - Country:US
Practice Address - Phone:803-898-8405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CAROLINA DEPT OF MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC450746Medicaid
SC3354Medicare PIN