Healthcare Provider Details

I. General information

NPI: 1558342014
Provider Name (Legal Business Name): COVENANT TOWERS HOMEOWNERS ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 LITTLE RIVER RD
MYRTLE BEACH SC
29577-2478
US

IV. Provider business mailing address

5001 LITTLE RIVER RD
MYRTLE BEACH SC
29577-2478
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-2484
  • Fax: 843-497-6238
Mailing address:
  • Phone: 843-449-2484
  • Fax: 843-497-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF-469
License Number StateSC

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. DEBBIE M HENDRICK
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 843-449-2484