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General NPI Number Information
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NPI Number | 1912621483
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Entity Type | Organization
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Legal Business Name | SUMTER BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 3180 BROAD ST
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City | SUMTER
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State | SC
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Zip | 29150-1811
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Country | US
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Telephone | 803-971-4210
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Fax |
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Provider Business Mailing Address
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Address Line | 3180 BROAD ST
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City | SUMTER
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State | SC
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Zip | 29150-1811
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Country | US
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Telephone | 803-971-4210
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DWAN GATHERS
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Credential |
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Telephone | 803-971-4210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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