Healthcare Provider Details

I. General information

NPI: 1710061668
Provider Name (Legal Business Name): PALMETTO BROOKVIEW OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 THOMPSON ST
GAFFNEY SC
29340-3620
US

IV. Provider business mailing address

510 THOMPSON ST
GAFFNEY SC
29340-3620
US

V. Phone/Fax

Practice location:
  • Phone: 864-489-3101
  • Fax: 864-489-4888
Mailing address:
  • Phone: 864-489-3101
  • Fax: 864-489-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF-708
License Number StateSC

VIII. Authorized Official

Name: SUSAN SAIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 864-489-3101