1023136272 NPI number — REACH UPSTATE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023136272 NPI number — REACH UPSTATE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REACH UPSTATE, INC.
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:
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:
1023136272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 2413
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29304-1972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-591-2273
Provider Business Mailing Address Fax Number:
864-591-2245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 E. DANIEL MORGAN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29306-1972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-591-2273
Provider Business Practice Location Address Fax Number:
864-591-2245
Provider Enumeration Date:
03/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALVERT
Authorized Official First Name:
CHRISSY
Authorized Official Middle Name:
LITTLEJOHN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
864-591-2273

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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