Provider Demographics
NPI:1558409029
Name:JUVENILES UPHOLDING MORALS AND PRICIPLES OF SOCIETY
Entity Type:Organization
Organization Name:JUVENILES UPHOLDING MORALS AND PRICIPLES OF SOCIETY
Other - Org Name:JUMPS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-865-8851
Mailing Address - Street 1:8025 SPRINGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-2575
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8801 BLUFF RD
Practice Address - Street 2:
Practice Address - City:EASTOVER
Practice Address - State:SC
Practice Address - Zip Code:29044-9265
Practice Address - Country:US
Practice Address - Phone:803-353-0521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMC0070Medicaid