Provider Demographics
NPI:1477820504
Name:CHEROKEE CREEK BOYS SCHOOL
Entity Type:Organization
Organization Name:CHEROKEE CREEK BOYS SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-647-1885
Mailing Address - Street 1:198 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-3309
Mailing Address - Country:US
Mailing Address - Phone:864-647-1885
Mailing Address - Fax:866-382-1220
Practice Address - Street 1:198 COOPER RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-3309
Practice Address - Country:US
Practice Address - Phone:864-647-1885
Practice Address - Fax:866-382-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5108322D00000X
SC15740322D00000X
SC5259322D00000X
SC2584322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children