Provider Demographics
NPI:1437144771
Name:OAKHAVEN NURSING CENTER LLC
Entity Type:Organization
Organization Name:OAKHAVEN NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-393-9925
Mailing Address - Street 1:116 CASHUA ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3202
Mailing Address - Country:US
Mailing Address - Phone:843-393-9925
Mailing Address - Fax:843-393-6778
Practice Address - Street 1:123 OAK ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-2628
Practice Address - Country:US
Practice Address - Phone:843-393-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF890314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC369575Medicaid
SC425064Medicare Oscar/Certification