Healthcare Provider Details

I. General information

NPI: 1902769771
Provider Name (Legal Business Name): 1516 GRAYS HIGHWAY SC OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 GRAYS HWY
RIDGELAND SC
29936-5440
US

IV. Provider business mailing address

1516 GRAYS HWY
RIDGELAND SC
29936-5440
US

V. Phone/Fax

Practice location:
  • Phone: 843-726-5581
  • Fax: 843-726-3741
Mailing address:
  • Phone: 843-726-5581
  • Fax: 843-726-3741

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: JOSEF NEUMAN
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 718-916-1443