Provider Demographics
NPI:1275615205
Name:CAROLINA RESOURCES
Entity Type:Organization
Organization Name:CAROLINA RESOURCES
Other - Org Name:LEARNING RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-276-3200
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-0609
Mailing Address - Country:US
Mailing Address - Phone:803-276-3200
Mailing Address - Fax:803-276-3220
Practice Address - Street 1:1345 WILSON RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-3061
Practice Address - Country:US
Practice Address - Phone:803-276-3200
Practice Address - Fax:803-276-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME988Medicaid
SCDME988Medicaid