Provider Demographics
NPI:1477831063
Name:ANGELHANDS OF THE UPSTATE
Entity Type:Organization
Organization Name:ANGELHANDS OF THE UPSTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:864-205-5636
Mailing Address - Street 1:150 HENDRIX DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-8385
Mailing Address - Country:US
Mailing Address - Phone:864-205-5636
Mailing Address - Fax:864-595-9323
Practice Address - Street 1:150 HENDRIX DR
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-8385
Practice Address - Country:US
Practice Address - Phone:864-205-5636
Practice Address - Fax:864-595-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization