Healthcare Provider Details

I. General information

NPI: 1629553607
Provider Name (Legal Business Name): ROCK HILL TREATMENT SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 E MAIN ST
ROCK HILL SC
29730-5948
US

IV. Provider business mailing address

200 WELLING CIR
GREENVILLE SC
29607-3936
US

V. Phone/Fax

Practice location:
  • Phone: 803-526-7666
  • Fax:
Mailing address:
  • Phone: 803-526-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

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