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General NPI Number Information
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NPI Number | 1306244009
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Entity Type | Organization
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Legal Business Name | 180 HEALTH AND WELLNSS, LLC.
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Dates
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Enumeration Date | 12/11/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 308A CAMBRIDGE AVE W
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City | GREENWOOD
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State | SC
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Zip | 29646-2190
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Country | US
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Telephone | 864-980-9105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 49606
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City | GREENWOOD
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State | SC
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Zip | 29649-0011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMY MICHELLE GRIFFIN
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Credential | RN
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Telephone | 864-980-9105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | SC
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