Provider Demographics
NPI:1376976837
Name:SEED HARVEST TIME RESIDENTIAL BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:SEED HARVEST TIME RESIDENTIAL BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALIND
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA,PMHC
Authorized Official - Phone:843-319-7843
Mailing Address - Street 1:444 MANNING HWY
Mailing Address - Street 2:
Mailing Address - City:GREELEYVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29056-9299
Mailing Address - Country:US
Mailing Address - Phone:843-319-7843
Mailing Address - Fax:843-401-0006
Practice Address - Street 1:209 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3415
Practice Address - Country:US
Practice Address - Phone:843-401-0005
Practice Address - Fax:843-401-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1396044988OtherNPI
SC131BHSMedicaid