Healthcare Provider Details

I. General information

NPI: 1063413219
Provider Name (Legal Business Name): GRAND STRAND HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 SOCASTEE BLVD
MYRTLE BEACH SC
29588-7206
US

IV. Provider business mailing address

4452 SOCASTEE BLVD
MYRTLE BEACH SC
29588-7206
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-1137
  • Fax: 843-293-1999
Mailing address:
  • Phone: 843-293-1137
  • Fax: 843-293-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF573
License Number StateSC

VII. Legacy identifiers

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

# 1
Identifier0573NH
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MR. HAROLD D. BRANTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-293-1137