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NPI Code Detail

MEDICARE: CARLYLE SENIOR CARE OF WILLISTON LLC

MEDICARE: CARLYLE SENIOR CARE OF WILLISTON 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1609589001
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARLYLE SENIOR CARE OF WILLISTON LLC
Provider Business Mailing Address
First Line : 5721 SPRINGFIELD RD
Second Line :
City : WILLISTON
State : SC
Zip : 29853-1917
Country : US
Telephone Number : 803-266-3229
Fax Number : 803-266-2257
Provider Business Practice Location Address
First Line : 5721 SPRINGFIELD RD
Second Line :
City : WILLISTON
State : SC
Zip : 29853-1917
Country : US
Telephone Number : 803-266-3229
Fax Number : 803-266-2257
Authorized Official
Title or Position : MANAGER
Name : RICHARD CRANFORD
Credential :
Telephone Number : 843-799-0756
Provider Enumeration Date : 12/30/2022
Last Update Date : 02/10/2026

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Directions to “CARLYLE SENIOR CARE OF WILLISTON LLC ” Practice Location

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