1013939529 NPI number — RICHLAND COMMUNITY HEALTH CARE ASSOCIATION

Table of content: (NPI 1013939529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013939529 NPI number — RICHLAND COMMUNITY HEALTH CARE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHLAND COMMUNITY HEALTH CARE ASSOCIATION
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:
Provider Other Organization Name Type Code:
6
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:
1013939529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 LAUREL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29201-2623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-799-8407
Provider Business Mailing Address Fax Number:
803-252-9070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 FARROW RD
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-7607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-799-1284
Provider Business Practice Location Address Fax Number:
803-799-8148
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYSON
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
803-799-8407

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , with the licence number: 20390 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FQC030 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP4435 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CBP006 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: FQC043 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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