Provider Demographics
NPI:1013405976
Name:SEA ISLAND HEALTHCARE, LLC
Entity Type:Organization
Organization Name:SEA ISLAND HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, MSR
Authorized Official - Phone:843-310-9690
Mailing Address - Street 1:1004 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2310
Mailing Address - Country:US
Mailing Address - Phone:843-310-9690
Mailing Address - Fax:800-317-9690
Practice Address - Street 1:1004 10TH ST
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2310
Practice Address - Country:US
Practice Address - Phone:843-310-9690
Practice Address - Fax:800-317-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCON-18-02251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1814Medicaid