Provider Demographics
NPI:1821163544
Name:GLENN SPRINGS ACADEMY
Entity Type:Organization
Organization Name:GLENN SPRINGS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:RANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-583-4367
Mailing Address - Street 1:195 BOYS HOME RD
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:PAULINE
Mailing Address - State:SC
Mailing Address - Zip Code:29374-2011
Mailing Address - Country:US
Mailing Address - Phone:864-583-4367
Mailing Address - Fax:864-583-2774
Practice Address - Street 1:195 BOYS HOME RD
Practice Address - Street 2:
Practice Address - City:GLENN SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29374-2011
Practice Address - Country:US
Practice Address - Phone:864-583-4367
Practice Address - Fax:864-583-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-0008022001-CCI322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC983MXHMedicare ID - Type Unspecified