Provider Demographics
NPI:1144243502
Name:SCBMA
Entity Type:Organization
Organization Name:SCBMA
Other - Org Name:BETHEA BAPTIST HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPURLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-393-2867
Mailing Address - Street 1:157 HOME AVE
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-7625
Mailing Address - Country:US
Mailing Address - Phone:843-393-2867
Mailing Address - Fax:843-393-2458
Practice Address - Street 1:157 HOME AVE
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532
Practice Address - Country:US
Practice Address - Phone:843-393-2867
Practice Address - Fax:843-393-2458
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCBMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0189NFMedicaid
SC0189NFMedicaid