Provider Demographics
NPI:1912621483
Name:SUMTER BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SUMTER BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-971-4210
Mailing Address - Street 1:3180 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1811
Mailing Address - Country:US
Mailing Address - Phone:803-971-4210
Mailing Address - Fax:
Practice Address - Street 1:3180 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1811
Practice Address - Country:US
Practice Address - Phone:803-971-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital