Provider Demographics
NPI:1619032034
Name:RECOVERY CONCEPTS OF CAROLINA UPST LLC
Entity Type:Organization
Organization Name:RECOVERY CONCEPTS OF CAROLINA UPST LLC
Other - Org Name:RECOVERY CONCEPTS OF CAROLINA UPST LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:GAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAFNA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-306-8533
Mailing Address - Street 1:1653 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3791
Mailing Address - Country:US
Mailing Address - Phone:864-306-8533
Mailing Address - Fax:864-306-8513
Practice Address - Street 1:1653 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3791
Practice Address - Country:US
Practice Address - Phone:864-306-8533
Practice Address - Fax:864-306-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093317OtherPK