Provider Demographics
NPI:1598194789
Name:FLEETWOOD REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:FLEETWOOD 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 1:200 ANNE DR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2061
Mailing Address - Country:US
Mailing Address - Phone:864-859-9754
Mailing Address - Fax:864-859-0697
Practice Address - Street 1:200 ANNE DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2061
Practice Address - Country:US
Practice Address - Phone:864-859-9754
Practice Address - Fax:864-859-0697
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ARK SC OPERATOR HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-07
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF1046Medicaid
425018Medicare Oscar/Certification