# AID UPSTATE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023563459
- **Authorized official:** RAJEE RAO (CEO)
- **Authorized official phone:** (864) 250-0607

## Contact information

- **Practice address:** 811 PENDLETON ST, SUITE 11, GREENVILLE, SC 29601-3209
- **Practice address phone:** (864) 250-0607
- **Practice address fax:** (864) 250-0608
- **Mailing address:** PO BOX 105, GREENVILLE, SC 29602-0105
- **Mailing address phone:** (864) 250-0607
- **Mailing address fax:** (864) 250-0608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/15/2016
- **Last updated:** 12/02/2024