KIVA LODGE (NPI# 1366764870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
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 |
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 Name | Type Code |
---|---|
Mental Health of South Carolina | Other Name - Individual/Organization |
Street Address |
200 CLAUDE BUNDRICK RD |
City | BLYTHEWOOD |
State | SC |
Zip Code | 29016-9420 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 29016 |
Taxonomy Code | 261QM0850X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Adult Mental Health |
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] |
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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 |
Find all providers with the same taxonomy |
City | BLYTHEWOOD |
Zip Code | 29016 |
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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.