Healthcare Provider Details

I. General information

NPI: 1306244009
Provider Name (Legal Business Name): 180 HEALTH AND WELLNSS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308A CAMBRIDGE AVE W
GREENWOOD SC
29646-2190
US

IV. Provider business mailing address

PO BOX 49606
GREENWOOD SC
29649-0011
US

V. Phone/Fax

Practice location:
  • Phone: 864-980-9105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateSC

VIII. Authorized Official

Name: MRS. AMY MICHELLE GRIFFIN
Title or Position: OWNER
Credential: RN
Phone: 864-980-9105