Provider Demographics
NPI:1417448937
Name:GREENWOOD TREATMENT SPECIALISTS
Entity Type:Organization
Organization Name:GREENWOOD TREATMENT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM SPONSER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-616-5031
Mailing Address - Street 1:200 WELLING CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3936
Mailing Address - Country:US
Mailing Address - Phone:864-407-4160
Mailing Address - Fax:864-407-4155
Practice Address - Street 1:110 COURT AVE W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2749
Practice Address - Country:US
Practice Address - Phone:864-407-4160
Practice Address - Fax:864-407-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3336C0002XSuppliersPharmacyClinic Pharmacy