Provider Demographics
NPI:1013256080
Name:AMIKIDS PALMETTO, INC.
Entity Type:Organization
Organization Name:AMIKIDS PALMETTO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-674-0458
Mailing Address - Street 1:780 T BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29353-2342
Mailing Address - Country:US
Mailing Address - Phone:864-674-0458
Mailing Address - Fax:864-674-0460
Practice Address - Street 1:780 T BISHOP RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29353-2342
Practice Address - Country:US
Practice Address - Phone:864-674-0458
Practice Address - Fax:864-674-0460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMIKIDS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-0001004332001-CCI251S00000X, 320800000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children