Provider Demographics
NPI:1235653395
Name:MONARCH EDUCATIONAL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MONARCH EDUCATIONAL ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHARISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:843-633-3895
Mailing Address - Street 1:307 N GOOSE CREEK BLVD UNIT 1641
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-8365
Mailing Address - Country:US
Mailing Address - Phone:843-633-3895
Mailing Address - Fax:
Practice Address - Street 1:107 PERSIMMON CIR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5738
Practice Address - Country:US
Practice Address - Phone:843-633-3895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6308101YP2500X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP7853Medicaid