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NPI 1518606805

NPI 1518606805 : SPRING ISLAND OPCO LLC : GEORGETOWN, SC

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General NPI Number Information
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    NPI Number           |    1518606805
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    Entity Type          |    Organization 
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    Legal Business Name  |    SPRING ISLAND OPCO LLC 
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Dates
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    Enumeration Date     |    06/03/2022
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    Last Update Date     |    06/03/2022
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Provider Practice Location Address
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    Address Line         |    2715 SOUTH ISLAND RD 
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    City                 |    GEORGETOWN
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    State                |    SC
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    Zip                  |    29440-4415
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    Country              |    US
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    Telephone            |    843-526-4123
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    Fax                  |    843-527-4465
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Provider Business Mailing Address
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    Address Line         |    2715 SOUTH ISLAND RD 
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    City                 |    GEORGETOWN
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    State                |    SC
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    Zip                  |    29440-4415
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    Country              |    US
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    Telephone            |    843-526-4123
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    Fax                  |    843-527-4465
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Authorized Official
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    Title or Position    |    MANAGER/AUTHORIZED SIGNATORY
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    Name                 |     JOE  NEUMAN 
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    Credential           |    
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    Telephone            |    718-916-1443
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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       |    
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    License Number State |    
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