MEDICARE: FLORENCE COUNTY COMMISSION ON ALCOHOL AND DRU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	251S00000X	Community/Behavioral Health Agency	101Y00000X	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447583984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORENCE COUNTY COMMISSION ON ALCOHOL AND DRU

Provider Business Mailing Address
First Line	:	PO BOX 6196
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502
Country	:	US
Telephone Number	:	843-665-3929
Fax Number	:	843-667-1615

Provider Business Practice Location Address
First Line	:	601 GREGG AVENUE
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501
Country	:	US
Telephone Number	:	843-665-3928
Fax Number	:	843-667-1615

Authorized Official
Title or Position	:	CEO
Name	:	MR. RANDALL CRAIG COLE
Credential	:
Telephone Number	:	843-665-9349

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	11/06/2009

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Directions to “FLORENCE COUNTY COMMISSION ON ALCOHOL AND DRU ” Practice Location

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