Healthcare Provider Details

I. General information

NPI: 1588093330
Provider Name (Legal Business Name): SOUTHERN OAKS REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BENTZ RD
PIEDMONT SC
29673-1412
US

IV. Provider business mailing address

109 BENTZ RD
PIEDMONT SC
29673-1412
US

V. Phone/Fax

Practice location:
  • Phone: 864-845-5177
  • Fax: 864-845-5258
Mailing address:
  • Phone: 864-845-5177
  • Fax: 864-845-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE D MEER
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 629-626-0000