Provider Demographics
NPI:1912970674
Name:ANDERSON SCHOOL DISTRICT FIVE
Entity Type:Organization
Organization Name:ANDERSON SCHOOL DISTRICT FIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COMPLIANCE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-260-5053
Mailing Address - Street 1:400 PEARMAN DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-3100
Mailing Address - Country:US
Mailing Address - Phone:864-260-5000
Mailing Address - Fax:
Practice Address - Street 1:400 PEARMAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-3100
Practice Address - Country:US
Practice Address - Phone:864-260-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty
Not Answered164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSD0405Medicaid