Provider Demographics
NPI:1497711469
Name:FAIR PLAY CAMP SCHOOL, INC
Entity Type:Organization
Organization Name:FAIR PLAY CAMP SCHOOL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-647-4311
Mailing Address - Street 1:347 WILDERNESS TR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693
Mailing Address - Country:US
Mailing Address - Phone:864-647-4311
Mailing Address - Fax:864-647-4314
Practice Address - Street 1:347 WILDERNESS TRL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-3404
Practice Address - Country:US
Practice Address - Phone:864-647-4311
Practice Address - Fax:864-647-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-0008075001-CCI322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC980MXHMedicaid