Provider Demographics
NPI:1215024161
Name:LANCASTER CONVALESCENT CENTER INC
Entity Type:Organization
Organization Name:LANCASTER CONVALESCENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MYRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLYDOROU
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:864-582-8983
Mailing Address - Street 1:PO BOX 5419
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-5419
Mailing Address - Country:US
Mailing Address - Phone:864-582-8983
Mailing Address - Fax:
Practice Address - Street 1:2044 PAGELAND HWY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-7608
Practice Address - Country:US
Practice Address - Phone:803-285-7907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF551314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0551NHMedicaid
SC0551NHMedicaid