MEDICARE: CAROLINA OAKS BEHAVIORAL CARE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1831504950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA OAKS BEHAVIORAL CARE

Provider Business Mailing Address
First Line	:	1107 RIVER RD
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 RIVER RD
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8703
Country	:	US
Telephone Number	:	843-557-1184
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	PARKE SMITH
Credential	:	LPC
Telephone Number	:	843-697-3748

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/26/2014

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