Hammocks on the Edisto LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

HAMMOCKS ON THE EDISTO LLC

Practice address

2137 Hope Plantation Lane
Jacksonboro, SC 29452

Phone

(843) 276-9326

NPI assigned

Jul 19, 2019

Last updated

Dec 16, 2020By 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

William Jonas Coatsworth, MA, LPC, LAC, CAC-IINPI 1861926529

Title

Ceo/Chief of Clinical Services

Phone

(843) 806-3414

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William Jonas Coatsworth, MA, LPC, LAC, CAC-II

  • Addiction (Substance Use Disorder) Counselor
  • Charleston, SC
  • NPI 1861926529

  Substance Abuse Rehabilitation Facility

  NPD Authorized official

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1861045767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "JACKSONBORO",
            "state": "SC",
            "postal_code": "294520130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2137 HOPE PLANTATION LANE",
            "city": "JACKSONBORO",
            "state": "SC",
            "postal_code": "29452",
            "telephone_number": "843-276-9326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMMOCKS ON THE EDISTO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-19",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "COATSWORTH",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "JONAS",
        "authorized_official_title_or_position": "CEO/CHIEF OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "843-806-3414",
        "authorized_official_credential": "MA, LPC, LAC, CAC-II"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanna Andracka Kudla, FNP-BC

• Substance Abuse Rehabilitation Facility in Jacksonboro, SC
• Providers in Jacksonboro, SC by specialty
• Substance Abuse Rehabilitation Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.