# BLACK RIVER HEALTHCARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kingstree Women's Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699969733
- **Authorized official:** MS. BARBARA F. BROOKS (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (803) 433-6790

## Contact information

- **Practice address:** 500 THURGOOD MARSHALL BOULEVARD, SUITE A, KINGSTREE, SC 29556
- **Practice address phone:** (843) 355-1425
- **Practice address fax:** (843) 355-1429
- **Mailing address:** PO BOX 578, MANNING, SC 29102-0578
- **Mailing address phone:** (843) 355-1425
- **Mailing address fax:** (843) 355-1429

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VX0000X | Obstetrics Physician | 999 | SC | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/31/2007
- **Last updated:** 12/11/2008