Healthcare Provider Details

I. General information

NPI: 1467068304
Provider Name (Legal Business Name): BKD CONWAY SC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 SINGLETON RIDGE RD
CONWAY SC
29526-1101
US

IV. Provider business mailing address

872 SINGLETON RIDGE RD
CONWAY SC
29526-1101
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-3050
  • Fax:
Mailing address:
  • Phone: 843-347-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JOANNE K LESKOWICZ
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 414-918-5000