Provider Demographics
NPI:1528362753
Name:COVENANT WAY
Entity Type:Organization
Organization Name:COVENANT WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PRIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, CRCFA
Authorized Official - Phone:864-379-2570
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:DUE WEST
Mailing Address - State:SC
Mailing Address - Zip Code:29639-0307
Mailing Address - Country:US
Mailing Address - Phone:864-379-2570
Mailing Address - Fax:864-379-2571
Practice Address - Street 1:18 FRANK PRESSLY DRIVE
Practice Address - Street 2:
Practice Address - City:DUE WEST
Practice Address - State:SC
Practice Address - Zip Code:29639-0307
Practice Address - Country:US
Practice Address - Phone:864-379-2570
Practice Address - Fax:864-379-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-0775314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility