| Sandhills Intergrated Care, Inc. | |
|
2406 Madison Dr North Myrtle Beach SC 29582-4334 | |
| (843) 663-0748 | |
| (843) 663-0749 |
| Full Name | Sandhills Intergrated Care, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2406 Madison Dr, North Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Lachandra Troy (CEO) |
| Authorized Official Contact | 8437563008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandhills Intergrated Care, Inc. Po Box 532 Whiteville NC 28472-0532 Ph: (843) 756-3008 | Sandhills Intergrated Care, Inc. 2406 Madison Dr North Myrtle Beach SC 29582-4334 Ph: (843) 663-0748 |
| NPI Number | 1548757123 |
|---|---|
| Provider Enumeration Date | 04/18/2018 |
| Last Update Date | 02/10/2023 |
| Certification Date | 10/18/2022 |
| Medicare PECOS PAC ID | 1052732682 |
|---|---|
| Medicare Enrollment ID | O20200605001419 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548757123 | NPI | - | NPPES |
| GP8411 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (South Carolina) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Tricia M Payne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356740351 PECOS PAC ID: 1355631029 Enrollment ID: I20160608001790 |
| Provider Name | Kathleen Nancy Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679718688 PECOS PAC ID: 0244397511 Enrollment ID: I20200605001540 |
| Provider Name | Vicki Grigg Chacon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750922233 PECOS PAC ID: 1850750423 Enrollment ID: I20230630000109 |
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