Provider Demographics
NPI:1679930184
Name:ELIZABETH C. GRUENEBERGER
Entity Type:Organization
Organization Name:ELIZABETH C. GRUENEBERGER
Other - Org Name:TIDEHAVEN HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRUENEBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-971-8808
Mailing Address - Street 1:519 LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4365
Mailing Address - Country:US
Mailing Address - Phone:843-971-8808
Mailing Address - Fax:843-971-9636
Practice Address - Street 1:519 LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4365
Practice Address - Country:US
Practice Address - Phone:843-971-8808
Practice Address - Fax:843-971-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 2084P0804X
SC319202084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty