Provider Demographics
NPI:1962805291
Name:PALMETTO CAROLINA TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:PALMETTO CAROLINA TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-527-1250
Mailing Address - Street 1:3523 PELHAM RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4191
Mailing Address - Country:US
Mailing Address - Phone:864-527-1250
Mailing Address - Fax:864-203-2066
Practice Address - Street 1:325 INGLESBY PKWY UNIT F
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9117
Practice Address - Country:US
Practice Address - Phone:864-433-8443
Practice Address - Fax:864-433-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X, 261QR0405X
SC151093336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3336C0002XSuppliersPharmacyClinic Pharmacy