Healthcare Provider Details

I. General information

NPI: 1083692602
Provider Name (Legal Business Name): CARLYLE SENIOR CARE OF BISHOPVILLE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CHAPPELL DR
BISHOPVILLE SC
29010-1167
US

IV. Provider business mailing address

207 CHAPPELL DR
BISHOPVILLE SC
29010-1167
US

V. Phone/Fax

Practice location:
  • Phone: 803-484-5636
  • Fax: 803-484-6311
Mailing address:
  • Phone: 803-484-5636
  • Fax: 803-484-6311

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: MR. RICHARD S CRANFORD
Title or Position: CEO
Credential:
Phone: 803-484-5636