1598311359 NPI number — GERIATRIC HEALTH AND WELLNESS LTD CO.

Table of content: (NPI 1598311359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598311359 NPI number — GERIATRIC HEALTH AND WELLNESS LTD CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRIC HEALTH AND WELLNESS LTD CO.
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:
1598311359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 ATRIUM WAY STE 235
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29223-6383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-788-5916
Provider Business Mailing Address Fax Number:
803-788-9524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 STILL HOPES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-7164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-788-5916
Provider Business Practice Location Address Fax Number:
803-788-9564
Provider Enumeration Date:
08/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HIRTH
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
803-788-5916

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD17579 . This is a "STATE OF SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING, AND REGULATION" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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