Provider Demographics
NPI:1578553871
Name:CC-HILTON HEAD INC
Entity Type:Organization
Organization Name:CC-HILTON HEAD INC
Other - Org Name:BROAD CREEK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-803-8555
Mailing Address - Street 1:700 TIDEPOINTE WAY
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3040
Mailing Address - Country:US
Mailing Address - Phone:843-341-7200
Mailing Address - Fax:843-341-7299
Practice Address - Street 1:801 LEMON GRASS CT
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-3022
Practice Address - Country:US
Practice Address - Phone:843-341-7300
Practice Address - Fax:843-341-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-753314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425351Medicare ID - Type Unspecified