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General NPI Number Information
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NPI Number | 1376297150
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Entity Type | Organization
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Legal Business Name | HIDDEN SENTENCE THE REHAB PERIOD
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1731 RHYNES TRL
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City | ROCK HILL
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State | SC
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Zip | 29732-5566
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Country | US
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Telephone | 803-524-8909
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Fax |
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Provider Business Mailing Address
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Address Line | 1731 RHYNES TRL
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City | ROCK HILL
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State | SC
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Zip | 29732-5566
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Country | US
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Telephone | 803-524-8909
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. FREDREKA WILSON MOFFATT
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Credential |
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Telephone | 803-524-8909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health 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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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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 | 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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