Provider Demographics
NPI:1407906878
Name:ALLENDALE COUNTY HOSPITAL BOARD
Entity Type:Organization
Organization Name:ALLENDALE COUNTY HOSPITAL BOARD
Other - Org Name:LAFFITTE & WARREN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HIATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-632-3311
Mailing Address - Street 1:P.O. BOX 218
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:SC
Mailing Address - Zip Code:29827
Mailing Address - Country:US
Mailing Address - Phone:803-632-1176
Mailing Address - Fax:803-632-2410
Practice Address - Street 1:623 MEMORIAL AVE N
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810
Practice Address - Country:US
Practice Address - Phone:803-584-2128
Practice Address - Fax:803-584-2125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLENDALE COUNTY HOSPITAL BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QR1300X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC539Medicaid
SCRHC539Medicaid