Healthcare Provider Details

I. General information

NPI: 1174289961
Provider Name (Legal Business Name): LANCASTER TREATMENT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 N MAIN ST
LANCASTER SC
29720-2188
US

IV. Provider business mailing address

977 N MAIN ST
LANCASTER SC
29720-2188
US

V. Phone/Fax

Practice location:
  • Phone: 803-745-7001
  • Fax: 803-745-7002
Mailing address:
  • Phone: 803-745-7001
  • Fax: 803-745-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: BRENT TYLER BRADY
Title or Position: OWNER/PROGRAM SPONSOR
Credential: RPH
Phone: 864-616-5031