Provider Demographics
NPI:1790078582
Name:ADVANTAGE VETERANS SERVICES OF
Entity Type:Organization
Organization Name:ADVANTAGE VETERANS SERVICES OF
Other - Org Name:VETERANS VICTORY HOUSE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:HEYWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-224-3898
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29623-5285
Mailing Address - Country:US
Mailing Address - Phone:864-224-3898
Mailing Address - Fax:864-224-3609
Practice Address - Street 1:2461 SIDNEYS RD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-6783
Practice Address - Country:US
Practice Address - Phone:843-538-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90343336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0921NFMedicaid
4230291OtherNCPDP PROVIDER IDENTIFICATION NUMBER
425386Medicare Oscar/Certification