| Pinelands Group Home | |
|
201 E Luke Ave Summerville SC 29483-6834 | |
| (843) 851-0079 | |
| (843) 873-1002 |
| Full Name | Pinelands Group Home |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 201 E Luke Ave, Summerville, South Carolina |
| Authorized Official Name and Position | Joette Kizer (CEO) |
| Authorized Official Contact | 8438510079 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pinelands Group Home 201 E Luke Ave Summerville SC 29483-6834 Ph: (843) 851-0079 | Pinelands Group Home 201 E Luke Ave Summerville SC 29483-6834 Ph: (843) 851-0079 |
| NPI Number | 1003128182 |
|---|---|
| Provider Enumeration Date | 07/06/2010 |
| Last Update Date | 07/06/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003128182 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | SR0008195001CC1 (South Carolina) | Primary |
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