Healthcare Provider Details

I. General information

NPI: 1326313503
Provider Name (Legal Business Name): EMERICARE COUNTRYSIDE VILLAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 PELZER HWY
EASLEY SC
29642-2941
US

IV. Provider business mailing address

111 WESTWOOD PL STE 400
BRENTWOOD TN
37027-5057
US

V. Phone/Fax

Practice location:
  • Phone: 864-859-2312
  • Fax: 864-859-0167
Mailing address:
  • Phone: 615-221-2250
  • Fax: 615-221-2280

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