=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083597546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRINGTREE MANOR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2025
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 SPRINGTREE DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29223-7989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-741-2600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 519
-----------------------------------------------------
City | AUBURNDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33823-0519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-226-0358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE ASSISTANT
-----------------------------------------------------
Name | SAVITRI JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-226-0358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------