Healthcare Provider Details

I. General information

NPI: 1053704379
Provider Name (Legal Business Name): SAINT MATTHEWS HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DANTZLER ST
SAINT MATTHEWS SC
29135-1522
US

IV. Provider business mailing address

601 DANTZLER ST
SAINT MATTHEWS SC
29135-1522
US

V. Phone/Fax

Practice location:
  • Phone: 803-655-7101
  • Fax: 803-655-7180
Mailing address:
  • Phone: 803-655-7101
  • Fax: 803-655-7180

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: MELISSA KIZER
Title or Position: PRESIDENT
Credential:
Phone: 803-655-7101