Healthcare Provider Details

I. General information

NPI: 1013263433
Provider Name (Legal Business Name): HANNAH RESIDENTIAL MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 SHEMINALLY RD
PAMPLICO SC
29583-5700
US

IV. Provider business mailing address

3750 SHEMINALLY RD
PAMPLICO SC
29583-5700
US

V. Phone/Fax

Practice location:
  • Phone: 843-493-0001
  • Fax: 843-493-2840
Mailing address:
  • Phone: 843-493-0001
  • Fax: 843-493-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberRCF 0712
License Number StateSC

VIII. Authorized Official

Name: MR. RONALD E. HART SR.
Title or Position: OWNER
Credential: COB
Phone: 843-493-0001