Provider Demographics
NPI:1770188914
Name:AFFORDABLE INN HOUSING FOR SENIORS
Entity Type:Organization
Organization Name:AFFORDABLE INN HOUSING FOR SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANIGAULT
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE AIDE
Authorized Official - Phone:843-956-3374
Mailing Address - Street 1:806 AUGUSTINE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-4102
Mailing Address - Country:US
Mailing Address - Phone:843-550-7110
Mailing Address - Fax:
Practice Address - Street 1:806 AUGUSTINE ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-4102
Practice Address - Country:US
Practice Address - Phone:843-956-3374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care