Provider Demographics
NPI:1487652947
Name:LUTHERAN HOMES OF SC, INC
Entity Type:Organization
Organization Name:LUTHERAN HOMES OF SC, INC
Other - Org Name:RICE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PARKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-749-5116
Mailing Address - Street 1:300 MINISTRY DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2366
Mailing Address - Country:US
Mailing Address - Phone:803-749-5110
Mailing Address - Fax:803-749-5111
Practice Address - Street 1:100 FINLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9264
Practice Address - Country:US
Practice Address - Phone:803-691-5720
Practice Address - Fax:803-691-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-1075310400000X
SCNCF-831314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425387Medicare Oscar/Certification