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General NPI Number Information
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NPI Number | 1023563459
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Entity Type | Organization
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Legal Business Name | AID UPSTATE
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 811 PENDLETON ST SUITE 11
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City | GREENVILLE
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State | SC
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Zip | 29601-3209
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Country | US
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Telephone | 864-250-0607
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Fax | 864-250-0608
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Provider Business Mailing Address
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Address Line | PO BOX 105
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City | GREENVILLE
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State | SC
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Zip | 29602-0105
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Country | US
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Telephone | 864-250-0607
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Fax | 864-250-0608
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Authorized Official
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Title or Position | CEO
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Name | RAJEE RAO
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Credential |
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Telephone | 864-250-0607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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