Provider Demographics
NPI:1447582911
Name:WELLNESS RESTORATION CENTERS OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:WELLNESS RESTORATION CENTERS OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN NESS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:719-651-5102
Mailing Address - Street 1:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29578-1305
Mailing Address - Country:US
Mailing Address - Phone:843-448-4222
Mailing Address - Fax:843-448-4844
Practice Address - Street 1:507 ROBERT M GRISSOM PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-448-4222
Practice Address - Fax:843-448-4844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAN NESS ENTREPRISES, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty