Provider Demographics
NPI:1144404823
Name:HARMONY RESIDENTIAL CARE CENTER, LLC
Entity Type:Organization
Organization Name:HARMONY RESIDENTIAL CARE CENTER, LLC
Other - Org Name:IVY GROVE RESIDENTIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:OBIAJULU
Authorized Official - Middle Name:E
Authorized Official - Last Name:MELEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:864-488-2006
Mailing Address - Street 1:483 LOCKHART LN
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2841
Mailing Address - Country:US
Mailing Address - Phone:864-487-0869
Mailing Address - Fax:864-487-8837
Practice Address - Street 1:483 LOCKHART LN
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2841
Practice Address - Country:US
Practice Address - Phone:864-487-0869
Practice Address - Fax:864-487-8837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARMONY RESIDENTIAL CARE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC1458310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCRC1458OtherDHEC