Provider Demographics
NPI:1609137967
Name:THORNWELL
Entity type:Organization
Organization Name:THORNWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-923-5998
Mailing Address - Street 1:302 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-2507
Mailing Address - Country:US
Mailing Address - Phone:864-938-2100
Mailing Address - Fax:864-938-2122
Practice Address - Street 1:302 S BROAD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2507
Practice Address - Country:US
Practice Address - Phone:864-938-2100
Practice Address - Fax:864-938-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC199BHSMedicaid