Healthcare Provider Details

I. General information

NPI: 1871325969
Provider Name (Legal Business Name): SH1 HAPPY WOODS OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 HAPPY WOODS CT
MYRTLE BEACH SC
29588-2925
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 843-298-8888
  • Fax: 843-293-0078
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
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: TERRI BAKER
Title or Position: FINANCE AND LICENSING COORDINATOR
Credential:
Phone: 564-203-3620