Organization
SOUTHSIDE RES. CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROY L. BOWERS SR. (CEO)
(803) 364-0022
Entity
Organization
Contact information
Practice address
425 S. WHEELER AVE, PROS, SC 29127
(803) 364-0022
(803) 364-8250
Mailing address
425 S. WHEELER AVE, PROSPERITY, SC 29127
(803) 364-0022
(803) 364-8250
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/05/2008
Last updated
11/05/2008
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