204.10 Appendix A: Out-of-Home Placement Chart LIST OF APPROVED OUT-OF-HOME PLACEMENT MEDICAID PROVIDERS FOR PSYCHIATRIC/MENTAL HEALTH SERVICES Facilities must be licensed by SCDHEC and maintain licensure to qualify as an approved Medicaid Out-of-Home Placement. Facilities not included on this list must contact Behavioral Health Services program prior to placement of a Medicaid beneficiary, to determine if the facility qualifies for Medicaid. PROVIDER NPI NUMBER PROVIDER LEGACY# RIVERSIDE BEHAVIORAL HEALTH AT 1033437801 RTF036 WINWOOD FARM PINELANDS PRTF 1770890485 RTF037 LIGHTHOUSE CARE CENTER OF 1376633578 RTF030 AUGUSTA CAROLINA CHILDREN’S HOME 1699812453 RTF035 VENICE 1083852511 RTF033 NEW HOPE CAROLINAS 1831114735 RTF032 WILLOWGLEN ACADEMY 1124260427 RTF034 HAMPTON PRTF 1508017476 RTF031 COASTAL HARBOR TREATMENT 1679543672 RTF022 CENTER (Savannah, GA) MARSHALL I. PICKENS CHILDREN’S RTF007 1629017983 PROGRAM (GHS) PALMETTO 1356362784 RTF003 Charleston, SC) RIVERS MIDLANDS 1144253824 RTF004 PALMETTO LOW COUNTRY BHS 1134232671 RTF021 PALMETTO PEE DEE 1508979956 RTF024 SPRINGBROOK BEHAVIORAL HEALTH RTF001 1386603793 THREE RIVERS 1073509055 RTF023 WILLIAM S. HALL PSYCHIATRIC (DMH) RTF011 1932124096 1114984812 RTF005 YORK PLACE LIGHTHOUSE CARE CENTER OF 1194826081 RTF029 CONWAY
204.10 Appendix A: Out-of-Home Placement Chart LIST OF APPROVED OUT-OF-HOME PLACEMENT MEDICAID PROVIDERS FOR PSYCHIATRIC/MENTAL HEALTH SERVICES Facilities must be licensed by SCDHEC and maintain licensure to qualify as an approved Medicaid Out-of-Home Placement. Facilities not included on this list must contact Behavioral Health Services program prior to placement of a Medicaid beneficiary, to determine if the facility qualifies for Medicaid. PROVIDER NPI NUMBER PROVIDER LEGACY# RIVERSIDE BEHAVIORAL HEALTH AT WINWOOD FARM 1033437801 RTF036 PINELANDS PRTF 1770890485 RTF037 LIGHTHOUSE CARE CENTER OF AUGUSTA 1376633578 RTF030 CAROLINA CHILDREN’S HOME 1699812453 RTF035 VENICE 1083852511 RTF033 NEW HOPE CAROLINAS 1831114735 RTF032 WILLOWGLEN ACADEMY 1124260427 RTF034 HAMPTON PRTF 1508017476 RTF031 COASTAL HARBOR TREATMENT CENTER (Savannah, GA) 1679543672 RTF022 MARSHALL I. PICKENS CHILDREN’S PROGRAM (GHS) 1629017983 RTF007 PALMETTO Charleston, SC) 1356362784 RTF003 RIVERS MIDLANDS 1144253824 RTF004 PALMETTO LOW COUNTRY BHS 1134232671 RTF021 PALMETTO PEE DEE 1508979956 RTF024 SPRINGBROOK BEHAVIORAL HEALTH 1386603793 RTF001 THREE RIVERS 1073509055 RTF023 WILLIAM S. HALL PSYCHIATRIC (DMH) 1932124096 RTF011 YORK PLACE 1114984812 RTF005 LIGHTHOUSE CARE CENTER OF CONWAY 1194826081 RTF029