Provider Demographics
NPI:1508186917
Name:QHG OF SOUTH CAROLINA INC
Entity Type:Organization
Organization Name:QHG OF SOUTH CAROLINA INC
Other - Org Name:MULLINS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-925-4565
Mailing Address - Street 1:PO BOX 277631
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7631
Mailing Address - Country:US
Mailing Address - Phone:843-464-8211
Mailing Address - Fax:843-464-1330
Practice Address - Street 1:518 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3510
Practice Address - Country:US
Practice Address - Phone:843-464-8211
Practice Address - Fax:843-464-1330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QHG OF SOUTH CAROLINA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-08
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425312Medicare Oscar/Certification