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General NPI Number Information
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NPI Number | 1558990549
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Entity Type | Organization
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Legal Business Name | SOUTH ISLAND LIVING LLC
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 2902 S ISLAND RD
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City | GEORGETOWN
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State | SC
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Zip | 29440-4420
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Country | US
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Telephone | 843-545-5427
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Fax |
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Provider Business Mailing Address
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Address Line | 2902 S ISLAND RD
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City | GEORGETOWN
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State | SC
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Zip | 29440-4420
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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 | ADMINISTRATOR
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Name | FACILITY ADMINISTRATOR
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Credential |
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Telephone | 843-545-5427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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