Healthcare Provider Details

I. General information

NPI: 1033540703
Provider Name (Legal Business Name): SUPPLEMENTAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STABLE GATE RD
HILTON HEAD SC
29926-1059
US

IV. Provider business mailing address

1 STABLE GATE RD
HILTON HEAD SC
29926-1059
US

V. Phone/Fax

Practice location:
  • Phone: 803-301-0643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4306
License Number StateSC

VIII. Authorized Official

Name: LAUREN CHURCH
Title or Position: RRT
Credential:
Phone: 843-301-0643