Healthcare Provider Details

I. General information

NPI: 1881539070
Provider Name (Legal Business Name): HARBORSIDE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 MATHIS FERRY RD STE 100
MOUNT PLEASANT SC
29464-2987
US

IV. Provider business mailing address

1050 JOHNNIE DODDS BLVD # 1116
MT PLEASANT SC
29464-3684
US

V. Phone/Fax

Practice location:
  • Phone: 843-900-6742
  • Fax: 803-237-8387
Mailing address:
  • Phone: 843-900-6742
  • Fax: 843-962-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTINE DECASTRO
Title or Position: OWNER
Credential: MD
Phone: 843-900-6742