1366910903 NPI number — SC-GA2018 CAPSTONE REHABILITATION AND HEALTHCARE 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 1366910903 NPI number — SC-GA2018 CAPSTONE REHABILITATION AND HEALTHCARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SC-GA2018 CAPSTONE 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:
Provider Other Organization Name Type Code:
6
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:
1366910903
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:
864-668-3992
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 CRESTVIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASLEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29642-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-859-3236
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2018

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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