MEDICARE: SOUTH CAROLINA ADDICTION TREATMENT LLC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1801471347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CAROLINA ADDICTION TREATMENT LLC

Provider Business Mailing Address
First Line	:	1187 HOLLAND RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-5710
Country	:	US
Telephone Number	:	704-604-3515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1187 HOLLAND RD
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-5710
Country	:	US
Telephone Number	:	704-604-3515
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RYAN M LEDOUX
Credential	:
Telephone Number	:	704-604-3515

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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