Provider Demographics
NPI:1316369333
Name:PUT-BACK, A NON-PROFIT ORGANIZATION
Entity type:Organization
Organization Name:PUT-BACK, A NON-PROFIT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:REESE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:803-479-9238
Mailing Address - Street 1:8408 LITTLE JOHN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-5600
Mailing Address - Country:US
Mailing Address - Phone:803-783-1801
Mailing Address - Fax:803-776-8029
Practice Address - Street 1:8408 LITTLE JOHN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-5600
Practice Address - Country:US
Practice Address - Phone:803-783-1801
Practice Address - Fax:803-776-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health