Provider Demographics
NPI:1508250119
Name:JUMPS
Entity Type:Organization
Organization Name:JUMPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-447-1291
Mailing Address - Street 1:PO BOX 24463
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-4463
Mailing Address - Country:US
Mailing Address - Phone:803-447-1291
Mailing Address - Fax:
Practice Address - Street 1:222 JW NEAL CIRCLE
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061
Practice Address - Country:US
Practice Address - Phone:803-447-1291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health