=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326408535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BISHOP GADSDEN EPISCOPAL RETIREMENT COMMUNITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2016
-----------------------------------------------------
Last Update Date | 05/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BISHOP GADSDEN WAY
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-762-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 BISHOP GADSDEN WAY
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-762-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MS. SARAH TIPTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-406-6337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | NCF-0577
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------