Healthcare Provider Details

I. General information

NPI: 1477469849
Provider Name (Legal Business Name): GOOD SAMARITAN RESIDENTIAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 BUBZY RD
KINGSTREE SC
29556-5246
US

IV. Provider business mailing address

1356 BUBZY RD
KINGSTREE SC
29556-5246
US

V. Phone/Fax

Practice location:
  • Phone: 843-382-3530
  • Fax: 843-382-3560
Mailing address:
  • Phone: 843-382-3530
  • Fax: 843-382-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PAMELA MCCLARY
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 803-210-5860