Provider Demographics
NPI:1306844196
Name:BARNWELL COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity type:Organization
Organization Name:BARNWELL COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:CSPS, ICPS
Authorized Official - Phone:803-541-1245
Mailing Address - Street 1:179 FULDNER ROAD
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812
Mailing Address - Country:US
Mailing Address - Phone:803-541-1245
Mailing Address - Fax:803-541-1247
Practice Address - Street 1:179 FULDNER ROAD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812
Practice Address - Country:US
Practice Address - Phone:803-541-1245
Practice Address - Fax:803-541-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD31BAMedicaid