Provider Demographics
NPI:1619087889
Name:BILLIE HARDEE HOME FOR BOYS
Entity Type:Organization
Organization Name:BILLIE HARDEE HOME FOR BOYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:GATES
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-393-8600
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29540-0617
Mailing Address - Country:US
Mailing Address - Phone:843-393-8600
Mailing Address - Fax:843-393-6471
Practice Address - Street 1:1133 TIMMONSVILLE HWY
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-5077
Practice Address - Country:US
Practice Address - Phone:843-393-8600
Practice Address - Fax:843-393-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-0001422001-GH322D00000X
SCSR-0008053001-CCI322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC974MXHMedicaid
SC946MXHMedicaid