MEDICARE: SC-GA2018 PATEWOOD REHABILITATION AND HEALTHCARE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1619445251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SC-GA2018 PATEWOOD REHABILITATION AND HEALTHCARE CENTER, LLC

Provider Business Mailing Address
First Line	:	777 LOWNDES HILL ROAD
Second Line	:	BLDG. 2, SUITE 101
City	:	GREENVILLE
State	:	SC
Zip	:	29607
Country	:	US
Telephone Number	:	864-688-3992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 GRIFFITH RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-3503
Country	:	US
Telephone Number	:	864-990-1918
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEX PALEY
Credential	:
Telephone Number	:	914-390-4363

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	01/18/2021

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