Healthcare Provider Details

I. General information

NPI: 1770093684
Provider Name (Legal Business Name): SOCIAL REMEDIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 BERRY ST
MANNING SC
29102-2002
US

IV. Provider business mailing address

920 BERRY ST
MANNING SC
29102-2002
US

V. Phone/Fax

Practice location:
  • Phone: 803-225-6441
  • Fax:
Mailing address:
  • Phone: 803-225-6441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number462164732
License Number StateSC

VIII. Authorized Official

Name: MR. DOMINIC BRANDON SIMON
Title or Position: CEO
Credential: LMSW, CPT
Phone: 803-225-6441