Provider Demographics
NPI:1164491650
Name:BRIAN CENTER / ST ANDREWS, LLC
Entity Type:Organization
Organization Name:BRIAN CENTER / ST ANDREWS, LLC
Other - Org Name:ST ANDREWS BRIAN CENTER NURSING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-459-2977
Mailing Address - Street 1:3514 SIDNEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4437
Mailing Address - Country:US
Mailing Address - Phone:803-798-9715
Mailing Address - Fax:803-798-1731
Practice Address - Street 1:3514 SIDNEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4437
Practice Address - Country:US
Practice Address - Phone:803-798-9715
Practice Address - Fax:803-798-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF875314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC173286Medicaid
NC425129Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER