Provider Demographics
NPI:1144253824
Name:THREE RIVERS RESIDENTIAL TREATMENT MIDLANDS CAMPUS, INC.
Entity type:Organization
Organization Name:THREE RIVERS RESIDENTIAL TREATMENT MIDLANDS CAMPUS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOD
Authorized Official - Prefix:
Authorized Official - First Name:JOELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-851-5208
Mailing Address - Street 1:200 ERMINE RD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-2024
Mailing Address - Country:US
Mailing Address - Phone:803-791-9918
Mailing Address - Fax:803-926-5925
Practice Address - Street 1:200 ERMINE RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2024
Practice Address - Country:US
Practice Address - Phone:803-791-9918
Practice Address - Fax:803-926-5925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRTC-018323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRTF004Medicaid