MEDICARE: SEDGEWOOD MANOR HEALTHCARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467517649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEDGEWOOD MANOR HEALTHCARE CENTER LLC

Provider Business Mailing Address
First Line	:	1645 RIDGE RD
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-8432
Country	:	US
Telephone Number	:	803-776-3873
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 RIDGE RD
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-8432
Country	:	US
Telephone Number	:	803-776-3873
Fax Number	:	803-217-0365

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	SAVITRI JOHNSON
Credential	:
Telephone Number	:	863-226-0358

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/25/2024

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