WEST MAIN STREET COMMUNITY RESIDENCE - NPI 1437212479 - Intermediate Care Facility, Intellectual Disabilities in Columbia, SC

Q: What is the provider's specialty?

The provider's specialty is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

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About West Main Street Community Residence NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WEST MAIN STREET COMMUNITY RESIDENCE (NPI 1437212479) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Columbia, South Carolina and active in the NPI registry since December 2006. The organization lists Robert William Barfield, Deputy State Director Administratio, as its authorized official.

NPPES Registry Identity

NPI1437212479

Entity TypeOrganization

Primary Taxonomy315P00000X

Legal Business NameSC DEPT OF DISABILITIES & SPECIAL NEEDS

Location Address3440 HARDEN STREET EXTENSIONColumbia, SC 29203

Mailing AddressPost Office Box 4706, 3440 Harden Street ExtensionColumbia, SC 29240-4706 · (803) 898-9600 · Fax (803) 898-9653

Phone(803) 898-9600

Fax(803) 898-9653

Organization SubpartNo

Authorized OfficialRobert William BarfieldDeputy State Director Administratio · 80389899743

Enumeration DateDecember 19, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1437212479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities

Taxonomy Code315P00000X

Definition

An intermediate care facility providing services for individuals with intellectual disabilities.

3440 HARDEN STREET EXTENSION, Columbia, SC 29203

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Other Names 1

Other NameWest Main Street Community Residence

Other Identifiers 1

Medicaid0751NHSC

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SC DEPT OF DISABILITIES AND SPECIAL NEEDS