1619032034 NPI number — RECOVERY CONCEPTS OF CAROLINA UPST LLC

Table of content: (NPI 1619032034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619032034 NPI number — RECOVERY CONCEPTS OF CAROLINA UPST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY CONCEPTS OF CAROLINA UPST 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:
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:
1619032034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1653 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASLEY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29640-3791
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-306-8533
Provider Business Mailing Address Fax Number:
864-306-8513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1653 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASLEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29640-3791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-306-8533
Provider Business Practice Location Address Fax Number:
864-306-8513
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAFNA
Authorized Official First Name:
GAJENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
864-306-8533

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2093317 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com