Healthcare Provider Details

I. General information

NPI: 1083488183
Provider Name (Legal Business Name): SELF REGIONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 THOMSON CIR
ABBEVILLE SC
29620-5652
US

IV. Provider business mailing address

1325 SPRING ST
GREENWOOD SC
29646-3860
US

V. Phone/Fax

Practice location:
  • Phone: 864-366-5122
  • Fax: 864-366-6123
Mailing address:
  • Phone: 864-725-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW TOLBERT LOGAN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 864-725-4780