Provider Demographics
NPI:1538107271
Name:MORNINGSIDE OF SOUTH CAROLINA, L.P.
Entity Type:Organization
Organization Name:MORNINGSIDE OF SOUTH CAROLINA, L.P.
Other - Org Name:MORNINGSIDE OF LANCASTER (LEASED)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8214
Mailing Address - Street 1:400 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2094
Mailing Address - Country:US
Mailing Address - Phone:617-796-8387
Mailing Address - Fax:617-796-8375
Practice Address - Street 1:1004 HARDIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-1609
Practice Address - Country:US
Practice Address - Phone:803-285-8152
Practice Address - Fax:803-289-1778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORNINGSIDE OF SOUTH CAROLINA, L.P.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-03
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-1146310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05307IMedicaid
055307Medicare Oscar/Certification