Healthcare Provider Details

I. General information

NPI: 1609463900
Provider Name (Legal Business Name): ALTERNATIVE LIVING SOLUTIONS OF SOUTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S OCEAN BLVD STE 839
MYRTLE BEACH SC
29577-4545
US

IV. Provider business mailing address

1501 S OCEAN BLVD STE 839
MYRTLE BEACH SC
29577-4545
US

V. Phone/Fax

Practice location:
  • Phone: 704-612-0566
  • Fax: 704-498-4846
Mailing address:
  • Phone: 704-612-0566
  • Fax: 704-498-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier201221-1457506
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MRS. STEPHANIE RENEE SHINE-MORRISON
Title or Position: CEO
Credential:
Phone: 704-612-0566