MEDICARE: CC-HILTON HEAD INC

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	NCF-753	SC

General Provider Information

NPI Number	:	1578553871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CC-HILTON HEAD INC

Provider Business Mailing Address
First Line	:	233 S WACKER DR STE 8400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-6316
Country	:	US
Telephone Number	:	312-803-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 LEMON GRASS CT
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-3022
Country	:	US
Telephone Number	:	843-341-7300
Fax Number	:	843-341-7311

Authorized Official
Title or Position	:	COUNSEL
Name	:	TOMEK J KOSZYLKO
Credential	:
Telephone Number	:	312-803-8443

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	10/24/2025

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