Provider Demographics
NPI:1023181617
Name:LORIS COMMUNITY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:LORIS COMMUNITY HOSPITAL DISTRICT
Other - Org Name:LORIS EXTENDED CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:843-716-7106
Mailing Address - Street 1:3620 STEVENS STREET
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2953
Mailing Address - Country:US
Mailing Address - Phone:843-716-7106
Mailing Address - Fax:843-716-7026
Practice Address - Street 1:3620 STEVENS STREET
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2953
Practice Address - Country:US
Practice Address - Phone:843-716-7106
Practice Address - Fax:843-716-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF207314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC240637Medicaid
SC240637Medicaid
SC1015600001Medicare NSC