Provider Demographics
NPI:1013144682
Name:CDM CORP
Entity type:Organization
Organization Name:CDM CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDIDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-979-3273
Mailing Address - Street 1:10698 OCEAN HWY
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7978
Mailing Address - Country:US
Mailing Address - Phone:843-979-3273
Mailing Address - Fax:843-979-0270
Practice Address - Street 1:10698 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7978
Practice Address - Country:US
Practice Address - Phone:843-979-3273
Practice Address - Fax:843-979-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No305R00000XManaged Care OrganizationsPreferred Provider Organization