Healthcare Provider Details

I. General information

NPI: 1073689576
Provider Name (Legal Business Name): RILEY PSYCHIATRIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 PINOPOLIS RD
PINOPOLIS SC
29469-5067
US

IV. Provider business mailing address

2205 PINOPOLIS RD
PINOPOLIS SC
29469-5067
US

V. Phone/Fax

Practice location:
  • Phone: 843-499-2327
  • Fax:
Mailing address:
  • Phone: 843-499-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN163734
License Number StateGA

VIII. Authorized Official

Name: CYNTHIA RILEY
Title or Position: OWNER
Credential:
Phone: 770-722-2170