1235137779 NPI number — LUTHERAN HOMES OF SC, INC.

Table of content: (NPI 1235137779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235137779 NPI number — LUTHERAN HOMES OF SC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN HOMES OF SC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRANKE HEALTH CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235137779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MINISTRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRMO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29063-2366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-749-5110
Provider Business Mailing Address Fax Number:
803-749-5111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1885 RIFLE RANGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-9440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-856-4700
Provider Business Practice Location Address Fax Number:
843-856-4730
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HORTON
Authorized Official First Name:
PARKE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
803-749-5116

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  CRC-1082 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 800 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C425374 . This is a "UNITED AMERICAN INS CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7101BECRPSNF0B . This is a "BCBS OF MI" identifier . This identifiers is of the category "OTHER".




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