Provider Demographics
NPI:1619137114
Name:RAPHA RESIDENTIAL CARE
Entity Type:Organization
Organization Name:RAPHA RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-755-6541
Mailing Address - Street 1:3959 FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-9038
Mailing Address - Country:US
Mailing Address - Phone:803-755-6541
Mailing Address - Fax:803-955-0453
Practice Address - Street 1:3959 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-9038
Practice Address - Country:US
Practice Address - Phone:803-755-6541
Practice Address - Fax:803-955-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1466-C063104A0625X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness