Healthcare Provider Details

I. General information

NPI: 1558576389
Provider Name (Legal Business Name): METRO TREATMENT OF SOUTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 AIRPORT RD SUITE C
GREENVILLE SC
29607-2617
US

IV. Provider business mailing address

2500 MAITLAND CENTER PARKWAY SUITE 250
MAITLAND FL
32751-4174
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7952
  • Fax: 864-234-7985
Mailing address:
  • Phone: 407-351-7080
  • Fax: 407-351-6930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOTPN091
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number50004493
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MR. RODNEY WILLIAMS
Title or Position: CFO
Credential:
Phone: 407-351-7080