Healthcare Provider Details

I. General information

NPI: 1023181617
Provider Name (Legal Business Name): LORIS COMMUNITY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 STEVENS STREET
LORIS SC
29569-2953
US

IV. Provider business mailing address

3620 STEVENS STREET
LORIS SC
29569-2953
US

V. Phone/Fax

Practice location:
  • Phone: 843-716-7106
  • Fax: 843-716-7026
Mailing address:
  • Phone: 843-716-7106
  • Fax: 843-716-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF207
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier240637
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MRS. LINDA L JOHNSON
Title or Position: ADMINISTRATOR
Credential: RN MSN
Phone: 843-716-7106