Provider Demographics
NPI:1497148712
Name:SPARTANBURG HEALTH CARE LLC
Entity Type:Organization
Organization Name:SPARTANBURG HEALTH CARE LLC
Other - Org Name:VALLEY FALLS TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-503-0377
Mailing Address - Street 1:400 LOCUST GRV
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4831
Mailing Address - Country:US
Mailing Address - Phone:864-503-0377
Mailing Address - Fax:864-503-9631
Practice Address - Street 1:400 LOCUST GRV
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4831
Practice Address - Country:US
Practice Address - Phone:864-503-0377
Practice Address - Fax:864-503-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF1060Medicaid
425096Medicare Oscar/Certification