Healthcare Provider Details

I. General information

NPI: 1730148370
Provider Name (Legal Business Name): YOUTH OPTIONS UNDER TEEN HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 KENNEDY RD
WINNSBORO SC
29180-5906
US

IV. Provider business mailing address

14 KENNEDY RD P.O. BOX 645
WINNSBORO SC
29180-5906
US

V. Phone/Fax

Practice location:
  • Phone: 803-635-2736
  • Fax: 803-633-8187
Mailing address:
  • Phone: 803-635-2736
  • Fax: 803-633-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateSC

VIII. Authorized Official

Name: MRS. RUDENE BUDHOO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 803-635-2736