Provider Demographics
NPI:1306356639
Name:SOCIAL REMEDIES INC
Entity Type:Organization
Organization Name:SOCIAL REMEDIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:803-225-6441
Mailing Address - Street 1:920 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-2002
Mailing Address - Country:US
Mailing Address - Phone:803-225-6441
Mailing Address - Fax:
Practice Address - Street 1:920 BERRY ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2002
Practice Address - Country:US
Practice Address - Phone:803-225-6441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherUNITED HEALTH CARE
SC=========OtherHUMANA
SC=========Medicaid