1386603793 NPI number — CHESTNUT HILL MENTAL HEALTH CENTER, INC

Table of content: (NPI 1386603793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386603793 NPI number — CHESTNUT HILL MENTAL HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTNUT HILL MENTAL HEALTH CENTER, 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:
SPRINGBROOK BEHAVIORAL HEALTH SYSTEM
Provider Other Organization Name Type Code:
3
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:
1386603793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HAVENWOOD LN
Provider Second Line Business Mailing Address:
P.O. BOX 1005
Provider Business Mailing Address City Name:
TRAVELERS REST
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29690-9447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-834-8013
Provider Business Mailing Address Fax Number:
864-834-6977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HAVENWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVELERS REST
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29690-9447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-834-8013
Provider Business Practice Location Address Fax Number:
864-834-6977
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROWLEY
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
864-834-8013

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: HTL442 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119917 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: RTF001 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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