NPIMap

Organization Active NPI

Pee Dee Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lake City, SC
National Provider Identifier
1043636046
Registry record updated Mar 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
PEE DEE MENTAL HEALTH
Practice address
675 N Matthews Rd
Lake City, SC 29560-7027
Phone
(843) 394-7600
NPI assigned
Mar 14, 2014
Organization subpart
Yes
Parent organization
SOTH CAROLINA DEPARTMENT OF MENTAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robin Windham
Title
Ar Supervisor
Phone
(843) 629-2483

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

675 N Matthews Rd
Lake City, SC 29560-7027

Mailing address

4 Jessamine St
Andrews, SC 29510-4414

Other identifiers 1

IdentifierTypeStateIssuer
376241MedicaidSC

National Provider Directory

National Provider Directory
Tax ID family
Lexington Co Comm Men H61 organizations share this tax ID, including this one
Part of
Lexington Co Comm Men H

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Locations

675 N Matthews Rd
Lake City, SC 29560
Phone (843) 394-7419

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394755200000",
    "number": "1043636046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 JESSAMINE ST",
            "city": "ANDREWS",
            "state": "SC",
            "postal_code": "295104414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N MATTHEWS RD",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295607027",
            "telephone_number": "843-394-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEE DEE MENTAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOTH CAROLINA DEPARTMENT OF MENTAL HEALTH",
        "enumeration_date": "2014-03-14",
        "last_updated": "2014-03-14",
        "status": "A",
        "authorized_official_last_name": "WINDHAM",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "AR SUPERVISOR",
        "authorized_official_telephone_number": "843-629-2483"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376241",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.