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NPI Code Detail

MEDICARE: ROUSE COMMUNITY CARE HOME

MEDICARE: ROUSE COMMUNITY CARE HOME
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
1310400000XAssisted Living FacilityRC0328SC
2310400000XAssisted Living FacilityRC0238SC
3310400000XAssisted Living FacilityRC0327SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740664598
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROUSE COMMUNITY CARE HOME
Provider Business Mailing Address
First Line : PO BOX 134
Second Line :
City : STATE PARK
State : SC
Zip : 29147-0134
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8809 WILSON BLVD
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-1817
Country : US
Telephone Number : 803-513-6700
Fax Number :
Authorized Official
Title or Position : OWNER/ ADMINISTRATOR
Name : MRS. CHARLENE E ROUSE
Credential :
Telephone Number : 803-513-6700
Provider Enumeration Date : 07/10/2015
Last Update Date : 07/10/2015

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Directions to “ROUSE COMMUNITY CARE HOME ” Practice Location

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