Healthcare Provider Details

I. General information

NPI: 1659455442
Provider Name (Legal Business Name): PALMETTO ST. GEORGE OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DUKES ST
SAINT GEORGE SC
29477-2059
US

IV. Provider business mailing address

905 DUKES ST
SAINT GEORGE SC
29477-2059
US

V. Phone/Fax

Practice location:
  • Phone: 843-563-4602
  • Fax: 843-563-8063
Mailing address:
  • Phone: 843-563-4602
  • Fax: 843-563-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF-638
License Number StateSC

VIII. Authorized Official

Name: CHRISTINE FLANSBURG
Title or Position: ADMINISTRATOR
Credential:
Phone: 843-563-4602