Healthcare Provider Details

I. General information

NPI: 1710159330
Provider Name (Legal Business Name): SOUTH OFFICE OF RURAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4899 CAROLINA HWY
DENMARK SC
29042-1675
US

IV. Provider business mailing address

4899 CAROLINA HWY
DENMARK SC
29042-1675
US

V. Phone/Fax

Practice location:
  • Phone: 803-793-6000
  • Fax: 803-793-6192
Mailing address:
  • Phone: 803-793-6000
  • Fax: 803-793-6192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateSC

VIII. Authorized Official

Name: MRS. VIRGINA BERRY WHITE
Title or Position: PROGRAM DIRECTOR
Credential: LMSW
Phone: 803-793-6000