Provider Demographics
NPI:1215344635
Name:BEAUFORT, JASPER, HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:BEAUFORT, JASPER, HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-987-7439
Mailing Address - Street 1:721 N OKATIE HWY
Mailing Address - Street 2:PO BOX 357
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8276
Mailing Address - Country:US
Mailing Address - Phone:843-987-7439
Mailing Address - Fax:843-987-3104
Practice Address - Street 1:721 N OKATIE HWY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8276
Practice Address - Country:US
Practice Address - Phone:843-987-7439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11021251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty