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General NPI Number Information
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NPI Number | 1174596936
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Entity Type | Organization
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Legal Business Name | CHESTERFIELD MARLBORO LP
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 711 CHESTERFIELD HWY
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City | CHERAW
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State | SC
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Zip | 29520-7002
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Country | US
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Telephone | 843-537-7881
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Fax | 843-320-3470
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Provider Business Mailing Address
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Address Line | PO BOX 198172
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City | ATLANTA
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State | GA
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Zip | 30384-8172
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTH OFFICIA / DIR BUSINESS OFFICE
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Name | LAURIE HOLTSFORD
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Credential |
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Telephone | 615-465-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | HTL-681
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License Number State | SC
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