Provider Demographics
NPI:1326324120
Name:REHOBOTH COMMUNITY ENRICHMENT SERVICE
Entity Type:Organization
Organization Name:REHOBOTH COMMUNITY ENRICHMENT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNSIDE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:864-266-2291
Mailing Address - Street 1:302 S LIMESTONE ST STE 3&4
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 S LIMESTONE ST STE 3&4
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-3000
Practice Address - Country:US
Practice Address - Phone:864-266-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health