Healthcare Provider Details

I. General information

NPI: 1346118171
Provider Name (Legal Business Name): BEYOND BASIC LIFE SKILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N GUM ST
SUMMERVILLE SC
29483-6830
US

IV. Provider business mailing address

406 N GUM ST
SUMMERVILLE SC
29483-6830
US

V. Phone/Fax

Practice location:
  • Phone: 843-459-5472
  • Fax:
Mailing address:
  • Phone: 843-459-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOLLY SMITH
Title or Position: CO-FOUNDER / CO-DIRECTOR
Credential:
Phone: 843-261-3880