MEDICARE: STEVE AUSTIN FACILITY OF CHARLESTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility		SC

General Provider Information

NPI Number	:	1609008713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVE AUSTIN FACILITY OF CHARLESTON

Provider Business Mailing Address
First Line	:	404 KERSHAW RD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-1940
Country	:	US
Telephone Number	:	843-276-0289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1383 REMOUNT RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-3345
Country	:	US
Telephone Number	:	516-361-5069
Fax Number	:

Authorized Official
Title or Position	:	TRESURER/SECRETARY
Name	:	MISS LOREAL ELISE DRAYTON
Credential	:
Telephone Number	:	843-276-0289

Provider Enumeration Date	:	08/23/2009
Last Update Date	:	08/23/2009

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