Healthcare Provider Details

I. General information

NPI: 1992411441
Provider Name (Legal Business Name): BACK TO BASICS HEALTH CARE SERVICES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 BRICKINGHAM WAY
COLUMBIA SC
29229-9551
US

IV. Provider business mailing address

821 BRICKINGHAM WAY
COLUMBIA SC
29229-9551
US

V. Phone/Fax

Practice location:
  • Phone: 803-529-9003
  • Fax: 803-306-6706
Mailing address:
  • Phone: 803-529-9003
  • Fax: 803-306-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. QUINCY POWELL SR.
Title or Position: MANAGING PARTNER
Credential:
Phone: 803-529-9000