Provider Demographics
NPI:1508906447
Name:SEABROOK OF HILTON HEAD, INC
Entity Type:Organization
Organization Name:SEABROOK OF HILTON HEAD, INC
Other - Org Name:FRASER HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHIGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-842-3747
Mailing Address - Street 1:300 WOODHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-7511
Mailing Address - Country:US
Mailing Address - Phone:843-842-3747
Mailing Address - Fax:
Practice Address - Street 1:300 WOODHAVEN DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928
Practice Address - Country:US
Practice Address - Phone:843-842-3747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF414314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
425150Medicare ID - Type Unspecified