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Organization
BLACK RIVER HEALTHCARE, INC.
Active
Organization
BLACK RIVER HEALTHCARE, INC.
Active
Parent organization
BLACK RIVER HEALTHCARE, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACK RIVER HEALTHCARE, INC.
Authorized official
MRS. BARBARA F. BROOKS (CHIEF EXECUTIVE OFFICER)
(803) 433-1216
Entity
Organization
Contact information
Practice address
206 EAST MARKET STREET, TIMMONSVILLE, SC 29161
(803) 433-1216
Mailing address
PO BOX 578, MANNING, SC 29102-0578
(803) 433-1216
(803) 433-6796
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
79153
SC
207Q00000X
Family Medicine Physician
Primary
27146
SC
208000000X
Pediatrics Physician
16299
SC
208D00000X
General Practice Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5009
MEDICARE PART B
SC
Enumeration date
07/09/2006
Last updated
01/06/2009
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