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NPI Code Detail

MEDICARE: CENTER OF HOPE OF MYRTLE BEACH, LLC

MEDICARE: CENTER OF HOPE OF MYRTLE BEACH, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist50007270SC
2251S00000XCommunity/Behavioral Health AgencyOTPN-0068SC
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
4261QM1300XMulti-Specialty Clinic/Center
5261QM2800XMethadone Clinic
6261QP2300XPrimary Care Clinic/Center
7261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1720302144
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTER OF HOPE OF MYRTLE BEACH, LLC
Provider Business Mailing Address
First Line : PO BOX 749057
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9057
Country : US
Telephone Number : 800-805-6989
Fax Number : 864-558-8511
Provider Business Practice Location Address
First Line : 104 GEORGE BISHOP PKWY
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29579-7335
Country : US
Telephone Number : 843-903-6212
Fax Number :
Authorized Official
Title or Position : CEO
Name : RUPERT JAMES MCCORMAC
Credential : MD
Telephone Number : 800-805-6989
Provider Enumeration Date : 03/15/2010
Last Update Date : 09/03/2024

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