Healthcare Provider Details

I. General information

NPI: 1659671634
Provider Name (Legal Business Name): BLOOMFIELD SENIOR LIVING OF BLUFFTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 OAK FOREST RD
BLUFFTON SC
29910-5010
US

IV. Provider business mailing address

60 OAK FOREST RD
BLUFFTON SC
29910-5010
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-2338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateSC

VIII. Authorized Official

Name: SCOTT KANTOR
Title or Position: PRESIDENT
Credential:
Phone: 312-854-7104