Provider Demographics
NPI:1235554395
Name:OWL'S CLUB INTERNATIONAL
Entity Type:Organization
Organization Name:OWL'S CLUB INTERNATIONAL
Other - Org Name:OWLS NEST RECOVERY COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-669-6088
Mailing Address - Street 1:PO BOX 7607
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-7607
Mailing Address - Country:US
Mailing Address - Phone:843-669-6088
Mailing Address - Fax:843-407-6775
Practice Address - Street 1:2528 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5926
Practice Address - Country:US
Practice Address - Phone:843-669-6088
Practice Address - Fax:843-407-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility