Healthcare Provider Details

I. General information

NPI: 1295205631
Provider Name (Legal Business Name): SC-GA2018 FLEETWOOD REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ANNE DR
EASLEY SC
29640-2061
US

IV. Provider business mailing address

777 LOWNDES HILL ROAD BLDG. 2, SUITE 101
GREENVILLE SC
29607
US

V. Phone/Fax

Practice location:
  • Phone: 864-859-9754
  • Fax:
Mailing address:
  • Phone: 864-688-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALEX PALEY
Title or Position: PRESIDENT
Credential:
Phone: 914-390-4363