Healthcare Provider Details

I. General information

NPI: 1073260048
Provider Name (Legal Business Name): SOUTHLAND HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S DARGAN ST
FLORENCE SC
29506-2559
US

IV. Provider business mailing address

722 S DARGAN ST
FLORENCE SC
29506-2559
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-4403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLES COMMANDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-669-4403