Provider Demographics
NPI:1205493871
Name:KERSHAW COUNTY BOARD OF DISABILITIES AND SPECIAL NEEDS
Entity type:Organization
Organization Name:KERSHAW COUNTY BOARD OF DISABILITIES AND SPECIAL NEEDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZENOBIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-432-4841
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-0310
Mailing Address - Country:US
Mailing Address - Phone:803-432-4841
Mailing Address - Fax:803-424-2280
Practice Address - Street 1:1619 JEFFERSON DAVIS HIGHWAY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020
Practice Address - Country:US
Practice Address - Phone:803-432-4841
Practice Address - Fax:803-424-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency