Healthcare Provider Details

I. General information

NPI: 1639842974
Provider Name (Legal Business Name): EDGEFIELD COMMUNITY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 WA REEL DR
EDGEFIELD SC
29824-4534
US

IV. Provider business mailing address

262 N UNIVERSITY AVE
FARMINGTON UT
84025-2975
US

V. Phone/Fax

Practice location:
  • Phone: 803-637-5312
  • Fax:
Mailing address:
  • Phone:
  • 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: JOHN MITCHELL
Title or Position: SECRETARY
Credential:
Phone: 385-988-3319