Provider Demographics
NPI:1740670108
Name:BEAUFORT COUNTY ALCOHOL & DRUG ABUSE DEPT.
Entity type:Organization
Organization Name:BEAUFORT COUNTY ALCOHOL & DRUG ABUSE DEPT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-255-6020
Mailing Address - Street 1:1905 DUKE ST
Mailing Address - Street 2:270
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4403
Mailing Address - Country:US
Mailing Address - Phone:843-255-6020
Mailing Address - Fax:
Practice Address - Street 1:1905 DUKE ST
Practice Address - Street 2:270
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-4403
Practice Address - Country:US
Practice Address - Phone:843-255-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD21BEMedicaid