Healthcare Provider Details

I. General information

NPI: 1154257186
Provider Name (Legal Business Name): TYH BLACKVILLE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 JONES BRIDGE RD
BLACKVILLE SC
29817-3066
US

IV. Provider business mailing address

320 W MERRICK RD
FREEPORT NY
11520-3248
US

V. Phone/Fax

Practice location:
  • Phone: 803-284-4313
  • Fax:
Mailing address:
  • Phone:
  • 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: JONATHAN PELMAN
Title or Position: CEO
Credential:
Phone: 917-923-0954