Provider Demographics
NPI:1790145787
Name:CHERAW BEHAVIORAL HEALTH INC
Entity Type:Organization
Organization Name:CHERAW BEHAVIORAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LISENBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-408-4396
Mailing Address - Street 1:319 CHESTERFIELD HWY
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-3052
Mailing Address - Country:US
Mailing Address - Phone:843-865-7181
Mailing Address - Fax:
Practice Address - Street 1:319 CHESTERFIELD HWY
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-3052
Practice Address - Country:US
Practice Address - Phone:843-865-7181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)