Provider Demographics
NPI:1972574101
Name:THE ERNEST E. KENNEDY CENTER
Entity Type:Organization
Organization Name:THE ERNEST E. KENNEDY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-719-3000
Mailing Address - Street 1:306 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-2629
Mailing Address - Country:US
Mailing Address - Phone:843-719-3000
Mailing Address - Fax:843-719-3025
Practice Address - Street 1:306 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-2629
Practice Address - Country:US
Practice Address - Phone:843-719-3000
Practice Address - Fax:843-719-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCM00113SC1Medicaid