1619162500 NPI number — CHARLESTON BIRTH PLACE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619162500 NPI number — CHARLESTON BIRTH PLACE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLESTON BIRTH PLACE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619162500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 HOSPITAL DR STE 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-818-1123
Provider Business Mailing Address Fax Number:
843-818-1126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9133 TIMBER ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-818-1123
Provider Business Practice Location Address Fax Number:
843-818-1126
Provider Enumeration Date:
09/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RATHBUN
Authorized Official First Name:
LESLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
843-818-1123

Provider Taxonomy Codes

  • Taxonomy code: 261QB0400X , with the licence number:  BC-007 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP4823 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com