1518436658 NPI number — SC-GA2018 THE RIDGE REHABILITATION AND HEALTHCARE CENTER, LLC

Table of content: LENETTE MARIE BUTTS (NPI 1639683238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518436658 NPI number — SC-GA2018 THE RIDGE REHABILITATION AND HEALTHCARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SC-GA2018 THE RIDGE REHABILITATION AND HEALTHCARE 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:
THE RIDGE REHABILITATION AND HEALTHCARE 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:
1518436658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 LOWNDES HILL ROAD
Provider Second Line Business Mailing Address:
BLDG. 2, SUITE 101
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-688-3992
Provider Business Mailing Address Fax Number:
864-688-3992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 WA REEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEFIELD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29824-4534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-637-5312
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PALEY
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-390-4363

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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