Provider Demographics
NPI:1952947848
Name:EPWORTH CHILDREN'S HOME
Entity type:Organization
Organization Name:EPWORTH CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TEDDI
Authorized Official - Middle Name:T
Authorized Official - Last Name:GARRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-256-7394
Mailing Address - Street 1:PO BOX 50466
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-0466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 TRENHOLM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-3371
Practice Address - Country:US
Practice Address - Phone:803-256-7394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child