Provider Demographics
NPI:1659455442
Name:PALMETTO ST. GEORGE OPERATING LLC
Entity Type:Organization
Organization Name:PALMETTO ST. GEORGE OPERATING LLC
Other - Org Name:ST. GEORGE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-563-4602
Mailing Address - Street 1:905 DUKES ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-2059
Mailing Address - Country:US
Mailing Address - Phone:843-563-4602
Mailing Address - Fax:843-563-8063
Practice Address - Street 1:905 DUKES ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2059
Practice Address - Country:US
Practice Address - Phone:843-563-4602
Practice Address - Fax:843-563-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-638314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0924NFMedicaid
SC425143Medicare Oscar/Certification