MEDICARE: LUTHERAN HOMES OF SC, INC.

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	NCF-688	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1770581209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN HOMES OF SC, INC.

Provider Business Mailing Address
First Line	:	300 MINISTRY DR
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2366
Country	:	US
Telephone Number	:	803-749-5110
Fax Number	:	803-749-5111

Provider Business Practice Location Address
First Line	:	201 FORTRESS DRIVE
Second Line	:
City	:	WHITE ROCK
State	:	SC
Zip	:	29177
Country	:	US
Telephone Number	:	803-732-3000
Fax Number	:	803-732-8817

Authorized Official
Title or Position	:	CFO
Name	:	MR. PARKE B HORTON
Credential	:
Telephone Number	:	803-749-5116

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/28/2015

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