Healthcare Provider Details

I. General information

NPI: 1174900971
Provider Name (Legal Business Name): LEAD HOUSE BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 HIGHWAY 160 W STE 101
FORT MILL SC
29708-8009
US

IV. Provider business mailing address

1750 HIGHWAY 160 W STE 101
FORT MILL SC
29708-8009
US

V. Phone/Fax

Practice location:
  • Phone: 704-858-3790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVIIN JAMES
Title or Position: MANAGING PARTNER
Credential:
Phone: 919-395-6766