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General NPI Number Information
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NPI Number | 1992411441
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Entity Type | Organization
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Legal Business Name | BACK TO BASICS HEALTH CARE SERVICES LLP
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 821 BRICKINGHAM WAY
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City | COLUMBIA
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State | SC
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Zip | 29229-9551
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Country | US
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Telephone | 803-529-9003
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Fax | 803-306-6706
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Provider Business Mailing Address
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Address Line | 821 BRICKINGHAM WAY
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City | COLUMBIA
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State | SC
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Zip | 29229-9551
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Country | US
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Telephone | 803-529-9003
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Fax | 803-306-6706
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. QUINCY POWELL SR.
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Credential |
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Telephone | 803-529-9000
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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 |
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Taxonomy #2
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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 |
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