Healthcare Provider Details

I. General information

NPI: 1134232671
Provider Name (Legal Business Name): PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 SPEISSEGGER DR
NORTH CHARLESTON SC
29405-8229
US

IV. Provider business mailing address

2777 SPEISSEGGER DR
NORTH CHARLESTON SC
29405-8229
US

V. Phone/Fax

Practice location:
  • Phone: 843-747-5830
  • Fax: 843-745-5170
Mailing address:
  • Phone: 843-747-5830
  • Fax: 843-745-5170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberRTC011
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberHTL729
License Number StateSC

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-768-3300