Provider Demographics
NPI:1558510370
Name:BAMBERG COUNTY DISABILITIES AND SPECIAL NEEDS BOARD
Entity Type:Organization
Organization Name:BAMBERG COUNTY DISABILITIES AND SPECIAL NEEDS BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TORRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-793-5003
Mailing Address - Street 1:16553 HERITAGE HWY
Mailing Address - Street 2:P.O. BOX 333
Mailing Address - City:DENMARK
Mailing Address - State:SC
Mailing Address - Zip Code:29042-8901
Mailing Address - Country:US
Mailing Address - Phone:803-793-5003
Mailing Address - Fax:803-793-3778
Practice Address - Street 1:16553 HERITAGE HWY
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:SC
Practice Address - Zip Code:29042-8901
Practice Address - Country:US
Practice Address - Phone:803-793-5003
Practice Address - Fax:803-793-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251C00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services