1457542763 NPI number — BELVEDERE NORTH AUGUSTA RESCUE, 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 1457542763 NPI number — BELVEDERE NORTH AUGUSTA RESCUE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELVEDERE NORTH AUGUSTA RESCUE, 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:
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:
1457542763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
237 OAKLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTERBORO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29488-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-549-3444
Provider Business Mailing Address Fax Number:
843-549-3474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 EDGEFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH AUGUSTA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29841-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-640-4105
Provider Business Practice Location Address Fax Number:
803-202-1796
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAFFIELD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
803-279-4512

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  013 , 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)





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