Provider Demographics
NPI:1902566755
Name:UNITED CEREBRAL PALSY OF SOUTH CAROLINA, INC
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF SOUTH CAROLINA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:404-536-7971
Mailing Address - Street 1:3300 NORTHEAST EXPY NE BLDG 9
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3932
Mailing Address - Country:US
Mailing Address - Phone:770-676-2000
Mailing Address - Fax:
Practice Address - Street 1:1101 HARBOR DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3658
Practice Address - Country:US
Practice Address - Phone:803-926-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services