Basic Information
| Provider Information | |||||||||
| NPI: | 1861996142 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KERSHAW HOSPITAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1315 ROBERTS ST | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290203737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034324311 | ||||||||
| FaxNumber: | 8034326351 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 ROBERTS ST | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290203737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034324311 | ||||||||
| FaxNumber: | 8034326351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2018 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | TEAGUE | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT VICE PRESIDENT, SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6159207000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.