Provider Demographics
NPI:1699006353
Name:MURRY'S COMMUNITY CARE HOME
Entity Type:Organization
Organization Name:MURRY'S COMMUNITY CARE HOME
Other - Org Name:WHITAKER'S COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:WHITAKER
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-786-8561
Mailing Address - Street 1:79 SAL SUE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3821
Mailing Address - Country:US
Mailing Address - Phone:803-786-8561
Mailing Address - Fax:803-714-1987
Practice Address - Street 1:79 SAL SUE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3821
Practice Address - Country:US
Practice Address - Phone:803-786-8561
Practice Address - Fax:803-714-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRC0210320800000X
SCRC0208320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness