Provider Demographics
NPI:1609008713
Name:STEVE AUSTIN FACILITY OF CHARLESTON
Entity Type:Organization
Organization Name:STEVE AUSTIN FACILITY OF CHARLESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRESURER/SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:LOREAL
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:DRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-276-0289
Mailing Address - Street 1:404 KERSHAW RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-1940
Mailing Address - Country:US
Mailing Address - Phone:843-276-0289
Mailing Address - Fax:
Practice Address - Street 1:1383 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3345
Practice Address - Country:US
Practice Address - Phone:516-361-5069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility