Healthcare Provider Details

I. General information

NPI: 1699555177
Provider Name (Legal Business Name): SH1 HARDIN OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 HARDIN ST
LANCASTER SC
29720-1609
US

IV. Provider business mailing address

5101 NE 82ND AVE STE 200
VANCOUVER WA
98662-6343
US

V. Phone/Fax

Practice location:
  • Phone: 803-801-1288
  • Fax: 803-289-1778
Mailing address:
  • Phone: 360-254-9442
  • Fax: 360-254-1770

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: TERRI LYNN BAKER
Title or Position: LICENSING COORDINATOR
Credential:
Phone: 503-998-5810