SHORELINE BEHAVIORAL HEALTH SERVICES (NPI# 1629467022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629467022 |
| Entity Type | Organization |
| Organization Name | SHORELINE BEHAVIORAL HEALTH SERVICES |
| Practice Address |
2404 Wise Rd Conway SC 29526-5521 |
| Mailing Address |
2404 Wise Road Conway SC 29528 |
| Practice Telephone | 8433658884 |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2015-01-22 |
| Authorized Official Name | JOHN COFFIN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8433658884 |
| Authorized Official Credential | ED |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
SC | Behavioral Health & Social Service Providers | |
| Y | 251S00000X | Community/Behavioral Health | 57-0741188 | SC | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 57-0741188 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164828729 | Shoreline Behavioral Health Services | Community/Behavioral Health | 2404 Wise Road, Conway, SC 29528-0136 | 2014-11-10 |
| 1508310426 | Shoreline Behavioral Health Services | Substance Abuse Rehabilitation Facility | 2404 Wise Rd, Conway, SC 29526-5521 | 2016-08-09 |
| 1730553199 | Shoreline Behavioral Health Services | Community/Behavioral Health | 2404 Wise Rd, Conway, SC 29526-5521 | 2015-11-23 |
| 1689019796 | Shoreline Behavioral Health Services | Substance Abuse Rehabilitation Facility | 2404 Wise Rd, Conway, SC 29526-5521 | 2013-05-02 |
| Street Address |
2404 WISE RD |
| City | CONWAY |
| State | SC |
| Zip Code | 29526-5521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134158231 | Horry County Comm On Alcohol & Drug Abuse | Substance Abuse Rehabilitation Facility | 2404 Wise Rd, Conway, SC 29526-5521 | 2006-07-01 |
| 1568075182 | Ovp Health Care, Inc. | Family Medicine | 2404 Wise Rd, Conway, SC 29526-5521 | 2020-08-24 |
| 1558990051 | Bailey Erin Ray | Counselor | 2404 Wise Rd, Conway, SC 29526-5521 | 2020-04-06 |
| 1447889985 | Danielle Remensnyder | Counselor | 2404 Wise Rd, Conway, SC 29526-5521 | 2020-04-06 |
| 1790317246 | Christina Ann Feathers | Counselor | 2404 Wise Rd, Conway, SC 29526-5521 | 2020-02-12 |
| 1205474814 | Ohio Valley Physicians Inc | Family Medicine | 2404 Wise Rd, Conway, SC 29526-5521 | 2019-12-13 |
| 1922642131 | Eric Michael Curtis | Counselor | 2404 Wise Rd, Conway, SC 29526-5521 | 2019-10-30 |
| 1033751045 | Lauren Grace Joosten | Social Worker | 2404 Wise Rd, Conway, SC 29526-5521 | 2019-10-10 |
| 1326689340 | Kelsie Massengill | Counselor | 2404 Wise Rd, Conway, SC 29526-5521 | 2019-10-01 |
| 1588127229 | Reshaya Mcbride | Counselor | 2404 Wise Rd, Conway, SC 29526-5521 | 2019-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457975237 | Terri L Champion | Massage Therapist | 172 Waccamaw Medical Park Court, Conway, SC 29526 | 2020-06-08 |
| 1689204398 | Alayna Defalco | Clinical Exercise Physiologist | 1320 501 Business, Unit E, Conway, SC 29526 | 2020-01-22 |
| 1124672662 | Proxsys Rx - Sc, LLC | Pharmacy | 300 Singelton Ridge Road, Conway, SC 29526 | 2019-08-01 |
| 1598227431 | Surgery Center of Conway Inc | Clinic/Center | 1405 Main Street, Conway, SC 29526 | 2019-04-01 |
| 1801374962 | Trevor James Hess | Specialist/Technologist | 905 One Landon Loop, Conway, SC 29526 | 2018-08-01 |
| 1851800817 | Katherine Ann Nimphius | Behavioral Analyst | 105 Timberline Dr, Conway, SC 29526 | 2017-09-21 |
| 1922544253 | William Houck | Specialist/Technologist | 925 One Landon Loop, Conway, SC 29526 | 2017-01-10 |
| 1952857278 | Courtney Jeanette Smith | Counselor | 164 Waccamaw Medical Park Dr., Conway, SC 29526 | 2016-08-28 |
| 1336502632 | Jebediah S. Christy, D.d.s - Conway, Pllc | Dentist | 2756 Church St, Conway, SC 29526 | 2016-04-04 |
| 1447615208 | Abl Enterprises, LLC | Optometrist | 113 Citadel Drive, Conway, SC 29526 | 2015-12-22 |
| Find all providers in zip 29526 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164828729 | Shoreline Behavioral Health Services | Community/Behavioral Health | 2404 Wise Road, Conway, SC 29528-0136 | 2014-11-10 |
| 1962836411 | Community Resource Solutions LLC Sc | Community/Behavioral Health | 7091 Horseshoe Cir, Conway, SC 29527-7503 | 2013-09-02 |
| 1952614653 | Potential Counseling Service | Community/Behavioral Health | 8377 Huntington Ct, Conway, SC 29527-7989 | 2010-07-22 |
| 1134446958 | Lighted Path Pllc | Community/Behavioral Health | 1124 Oak St, Suite 250, Conway, AR 72032-4318 | 2010-05-04 |
| 1699909911 | Conway County Community Service Inc. | Community/Behavioral Health | 816 N Creek Dr, Conway, AR 72032-4711 | 2009-05-14 |
| 1013197540 | Dayspring Behavioral Health | Community/Behavioral Health | 1270 Bruce St, Conway, AR 72034-6511 | 2007-11-13 |
| 1548772882 | Pediatrics Plus Community Connections | Community/Behavioral Health | 2740 College Ave, Conway, AR 72034-6141 | 2017-10-26 |
| 1255782934 | New Approaches Counseling | Community/Behavioral Health | 6720 Elbow Rd, Conway, SC 29527-6471 | 2016-06-24 |
| 1730553199 | Shoreline Behavioral Health Services | Community/Behavioral Health | 2404 Wise Rd, Conway, SC 29526-5521 | 2015-11-23 |
| 1881060440 | Kairos Foundation | Community/Behavioral Health | 235 Tilk Rd, Conway, AR 72032-6648 | 2015-08-18 |
| Find all providers in CONWAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.