Healthcare Provider Details

I. General information

NPI: 1700867223
Provider Name (Legal Business Name): GRAND STRAND SENIOR HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4237 RIVER HILLS DR SUITE 150
LITTLE RIVER SC
29566-6444
US

IV. Provider business mailing address

4237 RIVER HILLS DR SUITE 150
LITTLE RIVER SC
29566-6444
US

V. Phone/Fax

Practice location:
  • Phone: 843-281-2778
  • Fax: 843-281-2785
Mailing address:
  • Phone: 843-281-2778
  • Fax: 843-281-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGH WHITE
Title or Position: CEO
Credential:
Phone: 842-692-1104