Provider Demographics
NPI:1346451978
Name:COVENANT PLACE OF SUMTER, INC
Entity Type:Organization
Organization Name:COVENANT PLACE OF SUMTER, INC
Other - Org Name:COVENANT PLACE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RISLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LINDER
Authorized Official - Suffix:SR
Authorized Official - Credentials:NHA, CRCFA, CASP
Authorized Official - Phone:803-469-7007
Mailing Address - Street 1:2825 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1712
Mailing Address - Country:US
Mailing Address - Phone:803-469-7007
Mailing Address - Fax:803-469-7008
Practice Address - Street 1:2825 CARTER RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1712
Practice Address - Country:US
Practice Address - Phone:803-469-7022
Practice Address - Fax:803-469-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-632314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425402OtherPTAN NUMBER
SC425402OtherMEDICARE OSCAR/CERTIFICATION