Provider Demographics
NPI:1790820041
Name:MARION-DILLON COUNTY BOARD OF DISABILITIES AND SPECIAL NEEDS
Entity Type:Organization
Organization Name:MARION-DILLON COUNTY BOARD OF DISABILITIES AND SPECIAL NEEDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-423-4484
Mailing Address - Street 1:400 ML KING DRIVE
Mailing Address - Street 2:PO BOX 1082
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-1082
Mailing Address - Country:US
Mailing Address - Phone:843-423-4484
Mailing Address - Fax:843-423-0857
Practice Address - Street 1:400 ML KING DRIVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-1082
Practice Address - Country:US
Practice Address - Phone:843-423-4484
Practice Address - Fax:843-423-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-1377320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities