Basic Information
| Provider Information | |||||||||
| NPI: | 1891814943 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODLANDS TREATMENT CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 BROZZINI COURT | ||||||||
| Address2: | SUITE E | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296155340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642887636 | ||||||||
| FaxNumber: | 8642887978 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 BROZZINI CT. | ||||||||
| Address2: | SUITE E | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296155340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642887636 | ||||||||
| FaxNumber: | 8642887978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMAC | ||||||||
| AuthorizedOfficialFirstName: | RUPERT | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8642887636 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | IV | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | SC-10025-M | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.