Provider Demographics
NPI:1558079525
Name:LAUREL CREST RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:LAUREL CREST RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:803-365-0855
Mailing Address - Street 1:2817 ASHLAND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5009
Mailing Address - Country:US
Mailing Address - Phone:803-365-0854
Mailing Address - Fax:
Practice Address - Street 1:100 JOSEPH WALKER DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6971
Practice Address - Country:US
Practice Address - Phone:803-926-5271
Practice Address - Fax:803-791-1557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-09
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNCF-1001OtherDHEC