Healthcare Provider Details

I. General information

NPI: 1043291263
Provider Name (Legal Business Name): CLARENDON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 MCGILL LN
SAINT STEPHEN SC
29479-3196
US

IV. Provider business mailing address

PO BOX 1108
SAINT STEPHEN SC
29479-1108
US

V. Phone/Fax

Practice location:
  • Phone: 843-567-2307
  • Fax: 843-567-2305
Mailing address:
  • Phone: 843-567-2307
  • Fax: 846-567-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF738
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0738NF
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MS. CHRISTIE H BROWDER
Title or Position: CFO
Credential:
Phone: 803-433-2005