Healthcare Provider Details

I. General information

NPI: 1205077435
Provider Name (Legal Business Name): SEA ISLAND COMPREHENSIVE HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 MAYBANK HWY
JOHNS ISLAND SC
29455-4825
US

IV. Provider business mailing address

3627 MAYBANK HWY
JOHNS ISLAND SC
29455-4825
US

V. Phone/Fax

Practice location:
  • Phone: 843-559-4137
  • Fax: 843-559-9925
Mailing address:
  • Phone: 843-559-4137
  • Fax: 843-559-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. DAVID B RICHARDSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-559-4137