Healthcare Provider Details

I. General information

NPI: 1407633597
Provider Name (Legal Business Name): MIHS OF WINNSBORO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 GREENBRIER MOSSYDALE RD
WINNSBORO SC
29180-8932
US

IV. Provider business mailing address

28059 US 19 N STE 205
CLEARWATER FL
33761-2620
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-7501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GIULIANNA BOARI
Title or Position: CFO
Credential:
Phone: 714-713-4085