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General NPI Number Information
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NPI Number | 1497169254
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Entity Type | Organization
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Legal Business Name | HERMAN L. ANDERSON INC,
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 997 HIGHWAY 90
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City | CONWAY
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State | SC
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Zip | 29526-7520
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Country | US
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Telephone | 843-347-9280
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Fax |
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Provider Business Mailing Address
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Address Line | 997 HIGHWAY 90
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City | CONWAY
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State | SC
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Zip | 29526-7520
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Country | US
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Telephone | 843-347-9280
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JANICE C FLECKNOE
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Credential | ADMINISTRATOR
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Telephone | 843-347-9280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | CRC-1506
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License Number State | SC
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