Provider Demographics
NPI:1134232671
Name:PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:2777 SPEISSEGGER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8229
Mailing Address - Country:US
Mailing Address - Phone:843-747-5830
Mailing Address - Fax:843-745-5170
Practice Address - Street 1:2777 SPEISSEGGER DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8229
Practice Address - Country:US
Practice Address - Phone:843-747-5830
Practice Address - Fax:843-745-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRTC011323P00000X
SCHTL729283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRTF021Medicaid
SCA00729Medicaid
SC424006Medicare Oscar/Certification