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General NPI Number Information
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NPI Number | 1336564988
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Entity Type | Organization
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Legal Business Name | CAROLINA HEADACHE CENTER
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 132 MILESTONE WAY
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City | GREENVILLE
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State | SC
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Zip | 29615-5065
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Country | US
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Telephone | 864-288-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 132 MILESTONE WAY
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City | GREENVILLE
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State | SC
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Zip | 29615-5065
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Country | US
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Telephone | 864-288-6404
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Fax |
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | MELINDA TIMON
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Credential |
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Telephone | 864-288-6404
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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 | 3353
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 3444
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License Number State | SC
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