Provider Demographics
NPI:1679562078
Name:BARNWELL COUNTY NURSING HOME
Entity Type:Organization
Organization Name:BARNWELL COUNTY NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:803-259-5547
Mailing Address - Street 1:31 WREN ST
Mailing Address - Street 2:POST OFFICE BOX 807
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1528
Mailing Address - Country:US
Mailing Address - Phone:803-259-5547
Mailing Address - Fax:803-259-7350
Practice Address - Street 1:31 WREN ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1528
Practice Address - Country:US
Practice Address - Phone:803-259-5547
Practice Address - Fax:803-259-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC0006OtherMDS
SC212470Medicaid
SC425097Medicare ID - Type Unspecified