Provider Demographics
NPI:1093771719
Name:SLEEPY HOLLOW YOUTH, INC.
Entity Type:Organization
Organization Name:SLEEPY HOLLOW YOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPATEHOLTS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:843-200-4268
Mailing Address - Street 1:PO BOX 1202
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-1202
Mailing Address - Country:US
Mailing Address - Phone:843-200-4268
Mailing Address - Fax:843-572-6418
Practice Address - Street 1:122 JO FURR LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-7709
Practice Address - Country:US
Practice Address - Phone:843-851-8028
Practice Address - Fax:843-572-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR0008207001GH322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC925 MXHMedicaid