1285103713 NPI number — FAMILY RESTORATION COUNSELING SERVICES, LLC

Table of content: ALMA IVETTE ROCKMORE OT (NPI 1144894940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285103713 NPI number — FAMILY RESTORATION COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY RESTORATION COUNSELING SERVICES, LLC
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:
1285103713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110B HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29681-3226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-688-2618
Provider Business Mailing Address Fax Number:
864-688-2766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110B HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMPSONVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29681-3226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-688-2618
Provider Business Practice Location Address Fax Number:
864-688-2766
Provider Enumeration Date:
11/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
864-688-2618

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1437296480 . This is a "NPI" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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