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General NPI Number Information
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NPI Number | 1619390481
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Entity Type | Organization
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Legal Business Name | BERKELEY CITIZENS, INC.
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 1301 OLD HWY. 52 SOUTH
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City | MONCKS CORNER
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State | SC
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Zip | 29461
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Country | US
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Telephone | 843-761-0311
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Fax | 843-761-0303
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Provider Business Mailing Address
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Address Line | PO BOX 429
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City | MONCKS CORNER
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State | SC
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Zip | 29461-0429
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Country | US
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Telephone | 843-761-0311
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Fax | 843-761-0311
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ALICE E. SHOOK
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Credential |
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Telephone | 843-761-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | SC
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