Provider Demographics
NPI:1558891861
Name:THREE RIVERS RESIDENTIAL TREATMENT MIDLANDS CAMPUS
Entity Type:Organization
Organization Name:THREE RIVERS RESIDENTIAL TREATMENT MIDLANDS CAMPUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:200 ERMINE RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170
Mailing Address - Country:US
Mailing Address - Phone:803-791-9918
Mailing Address - Fax:
Practice Address - Street 1:200 ERMINE RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170
Practice Address - Country:US
Practice Address - Phone:803-791-9918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRTF0018OtherSTATE LICENSE
SCRTF004Medicaid