Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 164W00000X | Licensed Practical Nurse | | | | No |
| 2 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 3 | 251J00000X | Nursing Care | | | | No |
| 4 | 251K00000X | Public Health or Welfare | | | | No |
| 5 | 251V00000X | Voluntary or Charitable | | | | No |
| 6 | 253Z00000X | In Home Supportive Care | | | | Yes |
| 7 | 261QA0600X | Clinic/Center | Adult Day Care | | | No |
| 8 | 261QD1600X | Clinic/Center | Developmental Disabilities | | | No |
| 9 | 3104A0630X | Assisted Living Facility | Assisted Living, Behavioral Disturbances | | | No |
| 10 | 313M00000X | Nursing Facility/Intermediate Care Facility | | | | No |
| 11 | 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 12 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | | No |
| 13 | 385H00000X | Respite Care | | | | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1396446787 | MEDICAID | SOUTH CAROLINA | |
| 2 | EY1208 | MEDICAID | SOUTH CAROLINA | |