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General NPI Number Information
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NPI Number | 1740664598
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Entity Type | Organization
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Legal Business Name | ROUSE COMMUNITY CARE HOME
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 8809 WILSON BLVD
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City | COLUMBIA
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State | SC
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Zip | 29203-1817
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Country | US
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Telephone | 803-513-6700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 134
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City | STATE PARK
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State | SC
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Zip | 29147-0134
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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 | OWNER/ ADMINISTRATOR
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Name | MRS. CHARLENE E ROUSE
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Credential |
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Telephone | 803-513-6700
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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 | RC0328
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | RC0238
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | RC0327
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License Number State | SC
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