Healthcare Provider Details

I. General information

NPI: 1972018026
Provider Name (Legal Business Name): WELLMORE OF DANIEL ISLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ROBERT DANIEL DRIVE
CHARLESTON SC
29492
US

IV. Provider business mailing address

3530 TORINGDON WAY STE 204
CHARLOTTE NC
28277
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-1000
  • Fax:
Mailing address:
  • Phone: 704-246-1620
  • Fax: 704-246-1621

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. DONALD O. THOMPSON JR.
Title or Position: CEO
Credential:
Phone: 704-246-1616