Healthcare Provider Details

I. General information

NPI: 1518093624
Provider Name (Legal Business Name): ELISE M. BAILEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 RUTHERFORD RD
GREENVILLE SC
29609-4640
US

IV. Provider business mailing address

5 CRYSTAL SPRINGS RD #511
GREENVILLE SC
29615-3124
US

V. Phone/Fax

Practice location:
  • Phone: 864-232-2442
  • Fax:
Mailing address:
  • Phone: 864-298-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR101662
License Number StateSC

VIII. Authorized Official

Name: MS. ELISE M BAILEY
Title or Position: R.N.
Credential: R.N.
Phone: 864-298-0522