1992254882 NPI number — SR PLUS BEHAVIOR CONSULTANTS, 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 1992254882 NPI number — SR PLUS BEHAVIOR CONSULTANTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SR PLUS BEHAVIOR CONSULTANTS, 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:
1992254882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 MAIN ST # 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29582-3030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-763-5469
Provider Business Mailing Address Fax Number:
813-441-8362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 PITCHERS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE RIVER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29566-6798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-763-5469
Provider Business Practice Location Address Fax Number:
813-441-8362
Provider Enumeration Date:
10/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SCULTHORPE
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
813-763-5469

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 019435900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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