Provider Demographics
NPI:1568891059
Name:MCCORMICK REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:MCCORMICK REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-626-0000
Mailing Address - Street 1:204 HOLIDAY RD
Mailing Address - Street 2:
Mailing Address - City:MC CORMICK
Mailing Address - State:SC
Mailing Address - Zip Code:29835-3429
Mailing Address - Country:US
Mailing Address - Phone:864-391-2390
Mailing Address - Fax:864-391-2397
Practice Address - Street 1:204 HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:MC CORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835-3429
Practice Address - Country:US
Practice Address - Phone:864-391-2390
Practice Address - Fax:864-391-2397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ARK SC OPERATOR HOLDINGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-05
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF1053Medicaid
425171Medicare Oscar/Certification