Healthcare Provider Details

I. General information

NPI: 1992007355
Provider Name (Legal Business Name): COURTLYN HOUSE CRCF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10508 GARNERS FERRY RD
EASTOVER SC
29044-9352
US

IV. Provider business mailing address

10508 GARNERS FERRY RD
EASTOVER SC
29044-9352
US

V. Phone/Fax

Practice location:
  • Phone: 803-695-2158
  • Fax: 803-695-2746
Mailing address:
  • Phone: 803-695-2158
  • Fax: 803-695-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANN J. FINDLEY
Title or Position: OWNER/OPERATOR
Credential:
Phone: 803-695-2158