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
—
—
251S00000X
Community/Behavioral Health Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
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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