Healthcare Provider Details

I. General information

NPI: 1396499224
Provider Name (Legal Business Name): SPRING STREET SENIOR HOUSING OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 SPRING STREET
CHARLESTON SC
29403
US

IV. Provider business mailing address

44 MCNEILL PLZ
WHITEVILLE NC
28472-8602
US

V. Phone/Fax

Practice location:
  • Phone: 843-754-6940
  • Fax: 943-865-8123
Mailing address:
  • Phone: 910-642-0224
  • Fax: 910-642-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH V CALCUTT
Title or Position: CFO
Credential:
Phone: 910-815-3122