Healthcare Provider Details

I. General information

NPI: 1891814943
Provider Name (Legal Business Name): WOODLANDS TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BROZZINI CT. SUITE E
GREENVILLE SC
29615-5340
US

IV. Provider business mailing address

155 BROZZINI COURT SUITE E
GREENVILLE SC
29615-5340
US

V. Phone/Fax

Practice location:
  • Phone: 864-288-7636
  • Fax: 864-288-7978
Mailing address:
  • Phone: 864-288-7636
  • Fax: 864-288-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberSC-10025-M
License Number StateSC

VIII. Authorized Official

Name: DR. RUPERT JAMES MCCORMAC IV
Title or Position: OWNER
Credential: M.D.
Phone: 864-288-7636