Healthcare Provider Details

I. General information

NPI: 1972542082
Provider Name (Legal Business Name): CHESTER HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK DR
CHESTER SC
29706-9769
US

IV. Provider business mailing address

PO BOX 281449
ATLANTA GA
30384-1449
US

V. Phone/Fax

Practice location:
  • Phone: 803-581-9400
  • Fax:
Mailing address:
  • Phone: 803-581-9400
  • Fax:

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: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-465-7463