Healthcare Provider Details

I. General information

NPI: 1619907730
Provider Name (Legal Business Name): THE METHODIST OAKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 METHODIST OAKS DRIVE
ORANGEBURG SC
29115-9999
US

IV. Provider business mailing address

PO BOX 327
ORANGEBURG SC
29116-0327
US

V. Phone/Fax

Practice location:
  • Phone: 803-534-1212
  • Fax:
Mailing address:
  • Phone: 803-534-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberCRC 910
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License NumberH0105
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF 735
License Number StateSC

VIII. Authorized Official

Name: MRS. SUZANNE WARD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 803-535-1575