Provider Demographics
NPI:1225004344
Name:COMMANDER NURSING CENTER, INC
Entity Type:Organization
Organization Name:COMMANDER NURSING CENTER, INC
Other - Org Name:COMMANDER NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMMANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-661-2186
Mailing Address - Street 1:4438 PAMPLICO HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-8502
Mailing Address - Country:US
Mailing Address - Phone:843-669-3502
Mailing Address - Fax:843-667-9425
Practice Address - Street 1:4438 PAMPLICO HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-8502
Practice Address - Country:US
Practice Address - Phone:843-669-3502
Practice Address - Fax:843-667-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC233314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC192677Medicaid
SC425119Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
SC192677Medicaid