Provider Demographics
NPI:1326295916
Name:YORKTOWNE VILLAGE ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:YORKTOWNE VILLAGE ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-684-0183
Mailing Address - Street 1:40 ROSS CANNON ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1341
Mailing Address - Country:US
Mailing Address - Phone:803-684-0183
Mailing Address - Fax:
Practice Address - Street 1:40 ROSS CANNON ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1341
Practice Address - Country:US
Practice Address - Phone:803-684-0183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC 1368310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRC1368Medicaid