Healthcare Provider Details

I. General information

NPI: 1265755532
Provider Name (Legal Business Name): CHESTNUT HILL MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAVENWOOD LN
TRAVELERS REST SC
29690-9447
US

IV. Provider business mailing address

1 HAVENWOOD LN
TRAVELERS REST SC
29690-9447
US

V. Phone/Fax

Practice location:
  • Phone: 864-834-8013
  • Fax: 864-834-6977
Mailing address:
  • Phone: 864-834-8013
  • Fax: 864-834-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberRTF0001
License Number StateSC

VIII. Authorized Official

Name: MIKE ROWLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 864-834-8013