Healthcare Provider Details

I. General information

NPI: 1932134384
Provider Name (Legal Business Name): AMISUB OF SOUTH CAROLINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S HERLONG AVE
ROCK HILL SC
29732-1158
US

IV. Provider business mailing address

PO BOX 740772
ATLANTA GA
30374-0772
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-1234
  • Fax:
Mailing address:
  • Phone: 803-329-6730
  • Fax: 919-774-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number417
License Number StateSC

VIII. Authorized Official

Name: STEVE GILMORE
Title or Position: CFO
Credential:
Phone: 803-329-6829