Provider Demographics
NPI:1174013684
Name:SANDHILLS INTERGRATED CARE, INC.
Entity Type:Organization
Organization Name:SANDHILLS INTERGRATED CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LACHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-756-3008
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-0532
Mailing Address - Country:US
Mailing Address - Phone:843-756-3008
Mailing Address - Fax:843-756-3128
Practice Address - Street 1:4123 MEETING ST STE A
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2409
Practice Address - Country:US
Practice Address - Phone:843-756-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1184107542Medicaid
SCGP8411Medicaid