# POTTER'S HOUSE PALMETTO, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205297967
- **Authorized official:** JAY A. SPATEHOLTS M.ED. (CHIEF OFFICER RM & COMPLIANCE)
- **Authorized official phone:** (843) 200-4268

## Contact information

- **Practice address:** 104 E BERRY ST, LINCOLNVILLE, SC 29485-7204
- **Practice address phone:** (843) 200-4268
- **Mailing address:** 2414 CLEMENT'S FERRY RD., CHARLESTON, SC 29429

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/09/2016
- **Last updated:** 03/09/2016