KIVA LODGE


Address: 200 Claude Bundrick Rd, Blythewood, SC 29016-9420
Phone: 8037545478

KIVA LODGE (NPI# 1366764870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1366764870
Entity Type Organization
Organization Name KIVA LODGE
Other Organization Name MENTAL HEALTH OF SOUTH CAROLINA
Practice Address 200 Claude Bundrick Rd
Blythewood
SC 29016-9420
Mailing Address 11 S Firetower Ct
Blythewood
SC 29016
Practice Telephone 8037545478
Mailing Telephone 8037542328
Mailing Fax Number 8037542328
Enumeration Date 2010-02-25
Last Update Date 2010-02-25
Authorized Official Name MRS. RUTH Z TYLER (CARE PROVIDER)
Authorized Official Telephone 8037545478
Is Organization Subpart Y
Parent Organization Name CTHII

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 251S00000X Community/Behavioral Health Agencies
Y 261QM0850X Clinic/Center
Specialization: Adult Mental Health
Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
Mental Health of South Carolina Other Name - Individual/Organization

Office Location

Street Address 200 CLAUDE BUNDRICK RD
City BLYTHEWOOD
State SC
Zip Code 29016-9420

Providers in the same location

NPI Name Taxonomy Address Enumeration
1780728709 David Ralph Abney Counselor 200 Claude Bundrick Rd, Blythewood, SC 29016-9420 2007-02-16
1942531579 Carlissa Yvette Goodwin Case Manager/Care Coordinator 200 Claude Bundrick Rd, Blythewood, SC 29016-9420 2010-01-21
1942530233 Mental Health America Community Based Residential Treatment Facility, Mental Illness 200 Claude Bundrick Rd, Blythewood, SC 29016 2010-01-08
1285962886 Mha Counselor 200 Claude Bundrick Rd, Blythewood, SC 29016-9420 2009-11-20
1821237769 Tammra Buchanan Counselor 200 Claude Bundrick Rd, Blythewood, SC 29016-9420 2009-02-17
1902050362 Sharon Foster Sanders Nurse's Aide 200 Claude Bundrick Rd, Blythewood, SC 29016-9420 2008-11-12
1184807364 Jessie Driggers Counselor 200 Claude Bundrick Rd, Kiva Lodge, Blythewood, SC 29016-9420 2007-12-11
1528187457 Kimberly Hunter Shider Counselor 200 Claude Bundrick Rd, Kiva Lodge, Blythewood, SC 29016-9420 2007-03-29
1871612002 Norward Earl Jackson Counselor 200 Claude Bundrick Rd, Kiva, Blythewood, SC 29016-9420 2007-03-28
1679690572 Matrice Sharnan Rouse Counselor 200 Claude Bundrick Rd, Blythewood, SC 29016-9420 2007-03-23
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1275151870 Soo Ji Mun Student in an Organized Health Care Education/Training Program 3049 Gedney Circle, Blythewood, SC 29016 2020-07-09
1427600196 Josie Gandy Drew Britt Speech-Language Pathologist Langford Elementary, 480 Langford Road, Blythewood, SC 29016 2019-07-12
1740843093 Helping Hearts Development Corporation In Home Supportive Care 311 Blythewood Road, Blythewood, SC 29016 2019-04-22
1063933125 Shawn Tyler Registered Nurse 1017 Fulmer Road, Blythewood, SC 29016 2017-06-29
1497290852 Carolina Roses of Blythewood LLC Community Based Residential Treatment Facility, Mental Illness 5338 Hardscrabble Rd, Blythewood, SC 29016 2016-12-21
1598129512 Brooke L. Green Physical Therapy Assistant 428-3 Mcnulty Road, Blythewood, SC 29016 2016-04-06
1922468909 Prince George Transport Ambulance 200 Louthian Way, Blythewood, SC 29016 2016-03-03
1760849459 Sherry Macaluso Counselor 2008 Old Birch Drive, Blythewood, SC 29016 2016-01-26
1851559629 John C Cosby Jr Dmd Pa Dentist 745 University Village Drive, Blythewood, SC 29016 2008-05-29
1427242031 Fairfield Medical Associates,pa Specialist 428 2 Mcnulty Road, Blythewood, SC 29016 2007-08-28
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Taxonomy Information

Taxonomy Code 261QM0850X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Adult Mental Health

Taxonomy Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
Notes: [7/1/2003: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1497363527 Lumin Center, LLC Clinic/Center 306a Mills Ave, Greenville, SC 29605-4022 2020-07-15
1801431069 Lantana Recovery Clinic/Center 1470 Ben Sawyer Blvd Ste 6, Mount Pleasant, SC 29464-4593 2019-11-12
1407497803 Jouney Counseling, LLC Clinic/Center 439 Congaree Rd Ste 6, Greenville, SC 29607-2868 2019-10-07
1255801973 Sunspire Health Hilton Head LLC Clinic/Center 11 Arley Way Ste 101, Bluffton, SC 29910-4883 2018-11-26
1942791090 Family Medicine of Sayebrook, LLC Clinic/Center 106 Lansford Pl Ste 100, Myrtle Beach, SC 29588-6979 2018-05-24
1114455615 Magnolia Family Counseling LLC Clinic/Center 135 Eagles Nest Dr # B4, Seneca, SC 29678-2765 2017-05-26
1508235110 Health Access 360, LLC Clinic/Center 4711 Forest Dr Ste 3-276, Columbia, SC 29206-3125 2015-09-24
1043504806 Bakers Counseling Services, LLC Clinic/Center 12 Fairfield Rd Ste B3, Beaufort, SC 29907-2576 2011-06-08
1609180058 Brown Mitchell, LLC Clinic/Center 35 Msc, Charleston, SC 29409-1002 2010-07-27
1528387040 Mental Health America-beaufort/jasper Clinic/Center 2 Mathews Ct Ste C, Suite C, Hilton Head Island, SC 29926-3799 2010-05-24
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Competitor

Search similar providers

City BLYTHEWOOD
Zip Code 29016

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Dataset Information

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.

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