Provider Demographics
NPI:1881019172
Name:CAROLINA TARGETED CASE MANAGEMENT,LLC
Entity type:Organization
Organization Name:CAROLINA TARGETED CASE MANAGEMENT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:BISHOP
Authorized Official - Last Name:SWAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:803-981-4114
Mailing Address - Street 1:PO BOX 38091
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0536
Mailing Address - Country:US
Mailing Address - Phone:803-981-4114
Mailing Address - Fax:803-325-1269
Practice Address - Street 1:635 KNIGHTON HILL RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9270
Practice Address - Country:US
Practice Address - Phone:803-981-4114
Practice Address - Fax:803-325-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC63210171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty