LUCILLE MANOR COMMUNITY RESIDENTIAL CARE, LLP (NPI# 1124586599) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124586599 |
| Entity Type | Organization |
| Organization Name | LUCILLE MANOR COMMUNITY RESIDENTIAL CARE, LLP |
| Practice Address |
1004 R L Coward Rd Eastover SC 29044-9455 |
| Mailing Address |
27 Carriage Oaks Ct Columbia SC 29229-9300 |
| Practice Telephone | 8035460298 |
| Mailing Telephone | 8035460298 |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2019-03-05 |
| Authorized Official Name | JACQUELINE MACK MINTZ (ADMINISTRATOR) |
| Authorized Official Telephone | 8035460298 |
| Authorized Official Credential | CRCF |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| Street Address |
1004 R L COWARD RD |
| City | EASTOVER |
| State | SC |
| Zip Code | 29044-9455 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427470251 | Carla Nadine Boyd | Home Health Aide | 1156 B Old Mcgraw Rd, Eastover, SC 29044 | 2014-01-14 |
| 1982691796 | Vanessa K Wideman | Family Medicine | 1325 S Carolina Rd Ste 11, Eastover, SC 29044 | 2005-10-06 |
| 1730669789 | Eau Claire Cooperative Health Center Inc. | Pharmacy | 3041 Old Eastover Road, Eastover, SC 29044 | 2018-08-20 |
| 1811294978 | Eau Claire Cooperative Health Center, Inc. | Clinic/Center | 3041 Old Eastover Road, Eastover, SC 29044-2417 | 2011-02-24 |
| 1821290818 | Marguerite Lovett Knox | Nurse Practitioner | 1325 S Carolina Rd Ste 29, Eastover, SC 29044-5000 | 2007-06-03 |
| 1962914036 | Alex Ramon Wright | Social Worker | 860 S Carolina Rd, Eastover, SC 29044-5052 | 2017-10-30 |
| 1609328590 | Deidra Swails | Social Worker | 860 S Carolina Rd # 6, Eastover, SC 29044-5052 | 2016-10-26 |
| 1033760483 | Eau Claire Cooperative Health Center, Inc. | Pharmacy | 3041 Old Eastover Rd, Eastover, SC 29044-8303 | 2019-09-26 |
| 1881204899 | Wanda Kay Fulton | Nurse Practitioner | 3041 Old Eastover Rd, Eastover, SC 29044-8303 | 2020-08-04 |
| 1871133728 | Melissa R. Scott | Nurse Practitioner | 3041 Old Eastover Rd, Eastover, SC 29044-8303 | 2020-01-08 |
| Find all providers in zip 29044 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497290852 | Carolina Roses of Blythewood LLC | Community Based Residential Treatment Facility, Mental Illness | 5338 Hardscrabble Rd, Blythewood, SC 29016 | 2016-12-21 |
| 1568912285 | Cbh of Anderson, Operating, LLC | Community Based Residential Treatment Facility, Mental Illness | 313 Williams St, Williamston, SC 29697-1928 | 2016-10-05 |
| 1235592072 | Dodababy Inc | Community Based Residential Treatment Facility, Mental Illness | 1775 Commissary St, N Charleston, SC 29405-1905 | 2016-03-30 |
| 1962880690 | Butterfly Services LLC | Community Based Residential Treatment Facility, Mental Illness | 1562 Fred Davis Road, Cheraw, SC 29520 | 2015-05-14 |
| 1144639881 | Mary's Angels Independent Living for Young Women | Community Based Residential Treatment Facility, Mental Illness | 29 Sunflower Dr, Cades, SC 29518-3312 | 2014-08-06 |
| 1730510066 | Elizabeth Bledsoe | Community Based Residential Treatment Facility, Mental Illness | 924 Barr Woods Rd, Saluda, SC 29138-8191 | 2013-12-12 |
| 1013256080 | Amikids Palmetto, Inc. | Community Based Residential Treatment Facility, Mental Illness | 780 T Bishop Rd, Jonesville, SC 29353-2342 | 2013-02-11 |
| 1811234206 | Carolina Health and Wellness | Community Based Residential Treatment Facility, Mental Illness | 317 Silver Fox Ln, Columbia, SC 29212-2491 | 2013-01-06 |
| 1033499827 | Joyce C Gregory | Community Based Residential Treatment Facility, Mental Illness | 2415 Fork Shoals Rd, Piedmont, SC 29673 | 2011-08-24 |
| 1699006353 | Murry's Community Care Home | Community Based Residential Treatment Facility, Mental Illness | 79 Sal Sue Ct, Columbia, SC 29203-3821 | 2010-01-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.