Healthcare Provider Details

I. General information

NPI: 1437495553
Provider Name (Legal Business Name): GEORGETOWN HC&R NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 S ISLAND RD
GEORGETOWN SC
29440-4415
US

IV. Provider business mailing address

2715 S ISLAND RD
GEORGETOWN SC
29440-4415
US

V. Phone/Fax

Practice location:
  • Phone: 843-526-4123
  • Fax: 843-527-4465
Mailing address:
  • Phone: 843-526-4123
  • Fax: 843-527-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BOYD P GENTRY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 678-869-5116