1649269085 NPI number — GRAND STRAND SENIOR HEALTH CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649269085 NPI number — GRAND STRAND SENIOR HEALTH CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAND STRAND SENIOR HEALTH CENTER, LLC
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:
Provider Other Organization Name Type Code:
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:
1649269085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5046 HIGHWAY 17 BYP S
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29588-4503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-839-6192
Provider Business Mailing Address Fax Number:
843-839-6164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5046 HIGHWAY 17 BYP S
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29588-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-839-6192
Provider Business Practice Location Address Fax Number:
843-839-6164
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BIRMINGHAM
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
615-373-7625

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP3814 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com