NPIMap

Organization Active NPI

Shoreline Behavioral Health Service

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Pawley's Island, SC
National Provider Identifier
1912345893
Registry record updated Jun 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
1112301 Issued in SC
Legal business name
SHORELINE BEHAVIORAL HEALTH SERVICE
Practice address
626 Tyson Dr
Pawleys Island, SC 29585-6925
Phone
(843) 318-6221
NPI assigned
Jun 12, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2013

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

Authorized official

Name
Mr. Charles Bell
Title
Director of Treatment Services
Phone
(843) 365-8884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 1112301 SC Primary

Addresses

Primary practice location

626 Tyson Dr
Pawleys Island, SC 29585-6925

Mailing address

626 Tyson Dr
Pawleys Island, SC 29585-6925
Phone (843) 318-6221

Other identifiers 1

IdentifierTypeStateIssuer
1112301OtherSCSCAADAC

National Provider Directory

National Provider Directory
Tax ID family
Horry County Comm on Alcohol 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.

NPI Registry JSON

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370995200000",
    "number": "1912345893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 TYSON DR",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295856925",
            "telephone_number": "843-318-6221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 TYSON DR",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295856925",
            "telephone_number": "843-318-6221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE BEHAVIORAL HEALTH SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-12",
        "last_updated": "2013-06-12",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DIRECTOR OF TREATMENT SERVICES",
        "authorized_official_telephone_number": "843-365-8884",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "SC",
            "license": "1112301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SCAADAC",
            "identifier": "1112301",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawley's Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; 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.