Healthcare Provider Details

I. General information

NPI: 1376297150
Provider Name (Legal Business Name): HIDDEN SENTENCE THE REHAB PERIOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 RHYNES TRL
ROCK HILL SC
29732-5566
US

IV. Provider business mailing address

1731 RHYNES TRL
ROCK HILL SC
29732-5566
US

V. Phone/Fax

Practice location:
  • Phone: 803-524-8909
  • Fax:
Mailing address:
  • Phone: 803-524-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MRS. FREDREKA WILSON MOFFATT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-524-8909