Tri-County Commission on Alcohol and Drug Abuse

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

License

HTL-0619 Issued in SC

Legal business name

TRI-COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE

Practice address

910 Cook Road
Orangeburg, SC 29118

Phone

(803) 536-4900

NPI assigned

Aug 5, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Richard S. Fowler

Title

Executive Director

Phone

(803) 536-4900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wlliam J. McCord Adolescent Treatment Facility Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Hospital certification: CCN 424013

Legal name

TRI-COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE

Certification status

Active

Provider type (POS)

Hospital – Psychiatric

Participating since

Oct 11, 2011

Last certification

Oct 23, 2019

Beds

15

Ownership / control type

Private (not for profit)

Organization structure

OtherNon-profit

Enrollment address

910 Cook Rd
Orangeburg, SC 29118-2124
Hospital Psychiatric Unit

Hospital subgroups

Psychiatric

Tax ID family

Tri-County County Commission on Alcohol and Drug Abuse3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Tri-County Commission on Alcohol and Drug Abuse

  • Community/Behavioral Health Agency
  • Orangeburg, SC
  • NPI 1053659706
  NPD tax ID
• Tri-County County Commission on Alcohol and Drug Abuse

  • Substance Abuse Rehabilitation Facility
  • Orangeburg, SC
  • NPI 1770572448
  NPD tax ID

Locations

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280966400000",
    "number": "1710291372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1166",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161166",
            "telephone_number": "803-536-4900",
            "fax_number": "803-531-8419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 COOK ROAD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "29118",
            "telephone_number": "803-536-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-COUNTY COMMISSION ON ALCOHOL AND DRUG ABUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-05",
        "last_updated": "2010-08-05",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "803-536-4900",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "SC",
            "license": "HTL-0619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M00036SC1",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wlliam J. McCord Adolescent Treatment Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Tri-County Commission on Alcohol and Drug Abuse
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• Psychiatric Hospital in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Psychiatric Hospital in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.