Healthcare Provider Details

I. General information

NPI: 1043259542
Provider Name (Legal Business Name): GREENVILLE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD
GREENVILLE SC
29605-5611
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-8988
  • Fax:
Mailing address:
  • Phone: 864-797-6307
  • Fax: 864-797-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberHTL-343
License Number StateSC

VIII. Authorized Official

Name: MICHAEL C. RIORDAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 864-455-7978