Provider Demographics
NPI:1013263433
Name:HANNAH RESIDENTIAL MANOR, INC.
Entity Type:Organization
Organization Name:HANNAH RESIDENTIAL MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HART
Authorized Official - Suffix:SR
Authorized Official - Credentials:COB
Authorized Official - Phone:843-493-0001
Mailing Address - Street 1:3750 SHEMINALLY RD
Mailing Address - Street 2:
Mailing Address - City:PAMPLICO
Mailing Address - State:SC
Mailing Address - Zip Code:29583-5700
Mailing Address - Country:US
Mailing Address - Phone:843-493-0001
Mailing Address - Fax:843-493-2840
Practice Address - Street 1:3750 SHEMINALLY RD
Practice Address - Street 2:
Practice Address - City:PAMPLICO
Practice Address - State:SC
Practice Address - Zip Code:29583-5700
Practice Address - Country:US
Practice Address - Phone:843-493-0001
Practice Address - Fax:843-493-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRCF 0712311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRCF 0712Medicaid