Healthcare Provider Details

I. General information

NPI: 1467634410
Provider Name (Legal Business Name): ROCK CASTLE NURSING & NUTRITION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2007
Last Update Date: 12/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RIDGE TRAIL DR
COLUMBIA SC
29229-9061
US

IV. Provider business mailing address

700 RIDGE TRAIL DR
COLUMBIA SC
29229-9061
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-7369
  • Fax: 803-788-7335
Mailing address:
  • Phone: 803-699-7369
  • Fax: 803-788-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number68138
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number68138
License Number StateSC

VIII. Authorized Official

Name: MS. CAROLYN BARNETTE WATKINS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.A.,R.D.,R.N.,C.D.E
Phone: 803-699-7369