Shoreline Behavioral Health Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

57-0741188 Issued in SC

Legal business name

SHORELINE BEHAVIORAL HEALTH SERVICES

Practice address

2404 Wise Rd
Conway, SC 29526-5521

Phone

(843) 365-8884

NPI assigned

Jan 22, 2015

Last updated

Jan 22, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Coffin, ED

Title

Executive Director

Phone

(843) 365-8884

Specialties & licenses 2

Addresses

Other identifiers 1

Tax ID family

Shoreline2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Shoreline

  • Substance Abuse Rehabilitation Facility
  • Conway, SC
  • NPI 1912350901
  NPD tax ID

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

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1629467022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 WISE ROAD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "29528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 WISE RD",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295265521",
            "telephone_number": "843-365-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "COFFIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "843-365-8884",
        "authorized_official_credential": "ED"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SC",
            "license": "57-0741188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "57-0741188",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline Altman Shelley, APRN
• Traci Shelley
• Neely Power Shepheard, APRN, FNP-C
• Andrea Tiffany Sherwood
• Shoreline
• Matthew Shumaker, DO
• Patricia Michaelis Shuping, RN
• Rene Roman Silva Jr., MD
• Steven Silversparre, MS, SCAT, ATC
• Latoya Yolanda Simmons, MA

• Community/Behavioral Health Agency in Conway, SC
• Providers in Conway, SC by specialty
• Community/Behavioral Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; 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.