Provider Demographics
NPI:1811192115
Name:PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA
Other - Org Name:PRESBYTERIAN COMMUNITIES OF SC - COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:803-365-0855
Mailing Address - Street 1:700 DAVEGA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9698
Mailing Address - Country:US
Mailing Address - Phone:803-772-5885
Mailing Address - Fax:
Practice Address - Street 1:700 DAVEGA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-9698
Practice Address - Country:US
Practice Address - Phone:803-772-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN COMMUNITIES OF SOUTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-18
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF545314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF-1034Medicaid
SCNF-1034Medicaid
SC425396Medicare UPIN
SC425396Medicare Oscar/Certification