Healthcare Provider Details

I. General information

NPI: 1689950636
Provider Name (Legal Business Name): CROSSROADS TREATMENT CENTER OF COLUMBIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 BLUFF RD
COLUMBIA SC
29201-4809
US

IV. Provider business mailing address

200 E BROAD ST STE 300
GREENVILLE SC
29601-2891
US

V. Phone/Fax

Practice location:
  • Phone: 803-733-5855
  • Fax: 803-733-5892
Mailing address:
  • Phone: 800-805-6989
  • Fax: 864-558-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number13238
License Number StateSC

VIII. Authorized Official

Name: SCOTT MILLER
Title or Position: PHARMACIST
Credential:
Phone: 803-733-5855