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General NPI Number Information
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NPI Number | 1902769771
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Entity Type | Organization
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Legal Business Name | 1516 GRAYS HIGHWAY SC OPCO LLC
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1516 GRAYS HWY
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City | RIDGELAND
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State | SC
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Zip | 29936-5440
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Country | US
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Telephone | 843-726-5581
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Fax | 843-726-3741
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Provider Business Mailing Address
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Address Line | 1516 GRAYS HWY
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City | RIDGELAND
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State | SC
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Zip | 29936-5440
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Country | US
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Telephone | 843-726-5581
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Fax | 843-726-3741
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Authorized Official
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Title or Position | AUTHORIZED SIGNATORY
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Name | JOSEF 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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