Provider Demographics
NPI:1750448858
Name:PEACHTREE CENTRE CHEROKEE COUNTY LONG TERM HEALTH
Entity Type:Organization
Organization Name:PEACHTREE CENTRE CHEROKEE COUNTY LONG TERM HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-487-2717
Mailing Address - Street 1:1434 N. LIMESTONE STREET
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340
Mailing Address - Country:US
Mailing Address - Phone:864-487-2717
Mailing Address - Fax:864-487-2798
Practice Address - Street 1:1434 N. LIMESTONE STREET
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340
Practice Address - Country:US
Practice Address - Phone:864-487-2717
Practice Address - Fax:864-487-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC729310400000X
SCNCF323314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC377597Medicaid
SCRC0729Medicaid
SC425095Medicare Oscar/Certification
SCRC0729Medicaid