Healthcare Provider Details

I. General information

NPI: 1619788890
Provider Name (Legal Business Name): PRISMA HEALTH LTACH - BAPTIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7TH FLOOR 1330 TAYLOR ST
COLUMBIA SC
89201-2915
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-5010
  • Fax:
Mailing address:
  • Phone: 803-596-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: KRISTI LAWRENCE
Title or Position: DIR-ENROLLMENT & CVO
Credential:
Phone: 864-522-8611