Provider Demographics
NPI:1194394882
Name:MATCH POINT CHARLESTON LLC
Entity Type:Organization
Organization Name:MATCH POINT CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-936-2982
Mailing Address - Street 1:498 WANDO PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7904
Mailing Address - Country:US
Mailing Address - Phone:843-936-2982
Mailing Address - Fax:
Practice Address - Street 1:498 WANDO PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7904
Practice Address - Country:US
Practice Address - Phone:843-936-2982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care