Provider Demographics
NPI:1942691274
Name:ARJ SC INC
Entity Type:Organization
Organization Name:ARJ SC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:980-229-3788
Mailing Address - Street 1:5201 JOHNSONS BARN RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-7608
Mailing Address - Country:US
Mailing Address - Phone:980-229-3788
Mailing Address - Fax:
Practice Address - Street 1:5939 BRIGHTSTAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7691
Practice Address - Country:US
Practice Address - Phone:980-229-3788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC217BHSMedicaid