Healthcare Provider Details

I. General information

NPI: 1801895685
Provider Name (Legal Business Name): CHERAW HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MOFFAT ROAD
CHERAW SC
29520
US

IV. Provider business mailing address

PO BOX 967
CHERAW SC
29520-0967
US

V. Phone/Fax

Practice location:
  • Phone: 843-537-5253
  • Fax: 843-537-4014
Mailing address:
  • Phone: 843-537-5253
  • Fax: 843-537-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF602
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JOEL DYSON
Title or Position: ADMINISTRATOR VP
Credential:
Phone: 843-537-5253