Provider Demographics
NPI:1689847378
Name:BURGESS RESIDENTIAL CARE
Entity Type:Organization
Organization Name:BURGESS RESIDENTIAL CARE
Other - Org Name:M & M RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-496-0813
Mailing Address - Street 1:2591 S BREHENAN DR
Mailing Address - Street 2:2591 BREHENAN DR.
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6203
Mailing Address - Country:US
Mailing Address - Phone:843-665-6843
Mailing Address - Fax:
Practice Address - Street 1:2591 S BREHENAN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6203
Practice Address - Country:US
Practice Address - Phone:843-496-0813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies