Healthcare Provider Details

I. General information

NPI: 1669800512
Provider Name (Legal Business Name): LINLEY PARK REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 JAMES ST
ANDERSON SC
29625-2942
US

IV. Provider business mailing address

208 JAMES ST
ANDERSON SC
29625-2942
US

V. Phone/Fax

Practice location:
  • Phone: 864-934-7158
  • Fax: 864-226-7215
Mailing address:
  • Phone: 864-226-3427
  • Fax: 864-226-7215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierNF1047
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MICHELLE D MEER
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 629-626-0000