Provider Demographics
NPI:1023563459
Name:AID UPSTATE
Entity Type:Organization
Organization Name:AID UPSTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-250-0607
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29602-0105
Mailing Address - Country:US
Mailing Address - Phone:864-250-0607
Mailing Address - Fax:864-250-0608
Practice Address - Street 1:811 PENDLETON ST
Practice Address - Street 2:SUITE 11
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3209
Practice Address - Country:US
Practice Address - Phone:864-250-0607
Practice Address - Fax:864-250-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP7542Medicaid