Provider Demographics
NPI:1336471895
Name:CAROLINA CARE CENTER
Entity Type:Organization
Organization Name:CAROLINA CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-926-8226
Mailing Address - Street 1:7001 SAINT ANDREWS RD
Mailing Address - Street 2:STE 319
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1137
Mailing Address - Country:US
Mailing Address - Phone:803-926-8226
Mailing Address - Fax:866-263-6551
Practice Address - Street 1:1625 CHARLESTON HWY
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5049
Practice Address - Country:US
Practice Address - Phone:803-926-8226
Practice Address - Fax:866-263-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health