| Organization Name: | BLACK RIVER HEALTHCARE, INC. |
| NPI Number: | 1508809542 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBARA BROOKS (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 139 Main Street Olanta |
| State: | SC US |
| Postal Code: | 29114 |
| Phone Number: | 8034331216 |
| Fax Number: | 8034336796 |
| NPI Enumeration Date: | 06/14/2006 |
| NPI Last Update Date: | 04/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 27146 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |