Provider Demographics
NPI:1588678627
Name:MARION REGIONAL HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:MARION REGIONAL HEALTHCARE SYSTEM
Other - Org Name:MULLINS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-431-2405
Mailing Address - Street 1:518 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-3510
Mailing Address - Country:US
Mailing Address - Phone:843-464-8211
Mailing Address - Fax:843-464-1330
Practice Address - Street 1:518 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3510
Practice Address - Country:US
Practice Address - Phone:843-464-8211
Practice Address - Fax:843-464-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC828314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0562NHMedicaid
SC0562NHMedicaid