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Organization

BLACK RIVER HEALTHCARE, INC.

Active
Parent organization
BLACK RIVER HEALTHCARE, INC.
Other names
BRH - Manning
Organization subpart
Yes

Provider details

NPI number
Legal business name
BLACK RIVER HEALTHCARE, INC.
Authorized official
MS. BARBARA F. BROOKS (CHIEF EXECUTIVE OFFICER)
(803) 433-1216
Entity
Organization

Contact information

Practice address
12 W SOUTH ST, MANNING, SC 29102-2925
(803) 433-1216
(803) 433-6796
Mailing address
12 W SOUTH ST, PO BOX 578, MANNING, SC 29102-2925
(803) 433-1216
(803) 433-6796

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician
208000000X
Pediatrics Physician
261QR1300X
Rural Health Clinic/Center
16299
SC
363LF0000X
Family Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4398
MEDICARE PART B
Enumeration date
06/03/2006
Last updated
11/18/2010
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