1306844196 NPI number — BARNWELL COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE

Table of content: (NPI 1306844196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306844196 NPI number — BARNWELL COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARNWELL COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AXIS I CENTER OF BARNWELL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306844196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 FULDNER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNWELL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-541-1245
Provider Business Mailing Address Fax Number:
803-541-1247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 FULDNER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNWELL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-541-1245
Provider Business Practice Location Address Fax Number:
803-541-1247
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RUSH
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
803-541-1245

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AD31BA , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com