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General NPI Number Information
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NPI Number | 1124291414
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Entity Type | Organization
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Legal Business Name | SPARTANBURG CHRISTIAN DISCIPLESHIP CENTER'S REACH PROGRAM
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 150 KENSINGTON DR
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City | SPARTANBURG
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State | SC
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Zip | 29306-3983
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Country | US
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Telephone | 864-595-0515
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Fax | 864-595-0516
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Provider Business Mailing Address
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Address Line | PO BOX 170393
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City | SPARTANBURG
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State | SC
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Zip | 29301-0026
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Country | US
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Telephone | 864-595-0515
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Fax | 864-595-0516
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TOMMY E. QUICK
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Credential |
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Telephone | 864-595-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 102779
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License Number State | SC
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