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General NPI Number Information
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NPI Number | 1477546182
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Entity Type | Organization
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Legal Business Name | BLACKVILLE HEALTHCARE AND REHAB, LLC
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Dates
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Enumeration Date | 08/27/2005
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 1612 JONES BRIDGE RD
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City | BLACKVILLE
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State | SC
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Zip | 29817-3066
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Country | US
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Telephone | 803-284-4313
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Fax | 803-284-1746
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Provider Business Mailing Address
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Address Line | 1612 JONES BRIDGE RD
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City | BLACKVILLE
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State | SC
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Zip | 29817-3066
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Country | US
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Telephone | 803-284-4313
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Fax | 803-284-1746
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | HAIM CY PIZAM
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Credential |
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Telephone | 407-454-9096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH-755
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License Number State | SC
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