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Organization
HIDDEN SENTENCE THE REHAB PERIOD
Active
Organization
HIDDEN SENTENCE THE REHAB PERIOD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FREDREKA WILSON MOFFATT (EXECUTIVE DIRECTOR)
(803) 524-8909
Entity
Organization
Contact information
Practice address
1731 RHYNES TRL, ROCK HILL, SC 29732-5566
(803) 524-8909
Mailing address
1731 RHYNES TRL, ROCK HILL, SC 29732-5566
(803) 524-8909
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
324500000X
Substance Abuse Rehabilitation Facility
—
NULL
405300000X
Prevention Professional
—
NULL
405300000X
Prevention Professional
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260536140034111
501(C)3
SC
Enumeration date
02/09/2022
Last updated
02/09/2022
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