Organization
BLACK RIVER HEALTHCARE, INC.
Active
Parent organization
BLACK RIVER HEALTHCARE, INC.
Other names
BRH - Greeleyville
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACK RIVER HEALTHCARE, INC.
Authorized official
LESLIE FREEMAN (CREDENTIALING COORDINATOR)
(803) 433-1216
Entity
Organization
Contact information
Practice address
86 N MAIN ST, GREELEYVILLE, SC 29056-9374
(843) 426-2180
(843) 426-2182
Mailing address
PO BOX 578, MANNING, SC 29102-0578
(803) 433-1216
(803) 433-6796
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
985
SC
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4399
MEDICARE PART B
SC
Enumeration date
06/02/2006
Last updated
04/08/2008
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