Healthcare Provider Details

I. General information

NPI: 1649293580
Provider Name (Legal Business Name): SPARTANBURG HOSPITAL FOR RESTORATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 SERPENTINE DR
SPARTANBURG SC
29303-3026
US

IV. Provider business mailing address

389 SERPENTINE DR
SPARTANBURG SC
29303-3026
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-3235
  • Fax: 864-560-3158
Mailing address:
  • Phone: 864-560-3235
  • Fax: 864-560-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHTL - 685
License Number StateSC

VIII. Authorized Official

Name: MRS. ANITA M. BUTLER
Title or Position: CEO
Credential:
Phone: 864-560-3235