Provider Demographics
NPI:1407158801
Name:CARLYLE SENIOR CARE OF FLORENCE,LLC
Entity Type:Organization
Organization Name:CARLYLE SENIOR CARE OF FLORENCE,LLC
Other - Org Name:FLORENCE REHAB & NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CRANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-669-4374
Mailing Address - Street 1:133 W CLARKE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0722
Mailing Address - Country:US
Mailing Address - Phone:843-669-4374
Mailing Address - Fax:843-669-3053
Practice Address - Street 1:133 W CLARKE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-0722
Practice Address - Country:US
Practice Address - Phone:843-669-4374
Practice Address - Fax:843-669-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0840NFMedicaid
SC425163Medicare Oscar/Certification