Provider Demographics
NPI:1588645709
Name:CLARENDON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:CLARENDON MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-433-2005
Mailing Address - Street 1:PO BOX 1159
Mailing Address - Street 2:
Mailing Address - City:SUMMERTON
Mailing Address - State:SC
Mailing Address - Zip Code:29148-1159
Mailing Address - Country:US
Mailing Address - Phone:803-485-2317
Mailing Address - Fax:803-485-2708
Practice Address - Street 1:1527 URBANA RD
Practice Address - Street 2:
Practice Address - City:SUMMERTON
Practice Address - State:SC
Practice Address - Zip Code:29148-1159
Practice Address - Country:US
Practice Address - Phone:803-485-2317
Practice Address - Fax:803-485-2708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF736314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0736NFMedicaid
0674160007Medicare NSC
425300Medicare ID - Type Unspecified