Provider Demographics
NPI:1780416271
Name:UPSTATE TARHEELS, INC.
Entity type:Organization
Organization Name:UPSTATE TARHEELS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WRISTON
Authorized Official - Last Name:MARSHBURN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:864-642-6780
Mailing Address - Street 1:716 E GREENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4837
Mailing Address - Country:US
Mailing Address - Phone:864-642-6780
Mailing Address - Fax:
Practice Address - Street 1:716 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4837
Practice Address - Country:US
Practice Address - Phone:864-642-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care