1215344635 NPI number — BEAUFORT, JASPER, HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215344635 NPI number — BEAUFORT, JASPER, HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAUFORT, JASPER, HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215344635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 N OKATIE HWY
Provider Second Line Business Mailing Address:
PO BOX 357
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29936-8276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-987-7439
Provider Business Mailing Address Fax Number:
843-987-3104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 N OKATIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29936-8276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-987-7439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
ROLAND
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
843-987-7439

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  11021 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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