Healthcare Provider Details

I. General information

NPI: 1467497206
Provider Name (Legal Business Name): TRIDENT SENIOR HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 NORTHBROOK BLVD #A16
CHARLESTON SC
29406-9252
US

IV. Provider business mailing address

2070 NORTHBROOK BLVD #A16
CHARLESTON SC
29406-9252
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-0416
  • Fax:
Mailing address:
  • Phone: 843-797-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TIM LLOYD
Title or Position: V.P.
Credential:
Phone: 843-797-0416