Healthcare Provider Details

I. General information

NPI: 1871824532
Provider Name (Legal Business Name): COLLETON COURTYARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ACADEMY RD
WALTERBORO SC
29488-9208
US

IV. Provider business mailing address

210 ACADEMY RD
WALTERBORO SC
29488-9208
US

V. Phone/Fax

Practice location:
  • Phone: 843-538-8181
  • Fax:
Mailing address:
  • Phone: 843-538-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACEY SIMONE SCOTT
Title or Position: ADMINISTRATION
Credential:
Phone: 843-538-8181