MEDICARE: PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility
2	283Q00000X	Psychiatric Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	HTL0729	OTHER	SC	LICENSE

General Provider Information

NPI Number	:	1134232671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	2777 SPEISSEGGER DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8229
Country	:	US
Telephone Number	:	843-747-5830
Fax Number	:	843-745-5170

Provider Business Practice Location Address
First Line	:	2777 SPEISSEGGER DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8229
Country	:	US
Telephone Number	:	843-747-5830
Fax Number	:	843-745-5170

Authorized Official
Title or Position	:	SR VP CFO
Name	:	STEVE FILTON
Credential	:
Telephone Number	:	610-768-3300

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	03/25/2026

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