Provider Demographics
NPI:1891814943
Name:WOODLANDS TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:WOODLANDS TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCCORMAC
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:864-288-7636
Mailing Address - Street 1:155 BROZZINI COURT
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5340
Mailing Address - Country:US
Mailing Address - Phone:864-288-7636
Mailing Address - Fax:864-288-7978
Practice Address - Street 1:155 BROZZINI CT.
Practice Address - Street 2:SUITE E
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5340
Practice Address - Country:US
Practice Address - Phone:864-288-7636
Practice Address - Fax:864-288-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC-10025-M261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone