Provider Demographics
NPI:1619907730
Name:THE METHODIST OAKS
Entity Type:Organization
Organization Name:THE METHODIST OAKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-535-1575
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-0327
Mailing Address - Country:US
Mailing Address - Phone:803-534-1212
Mailing Address - Fax:
Practice Address - Street 1:1000 METHODIST OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-9999
Practice Address - Country:US
Practice Address - Phone:803-534-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCH0105251T00000X
SCCRC 910310400000X
SCNCF 735314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC323391Medicaid
SC323391Medicaid