Provider Demographics
NPI:1134431208
Name:HARVEST HEALTH & REHAB OF JOHNS ISLAND, LLC
Entity type:Organization
Organization Name:HARVEST HEALTH & REHAB OF JOHNS ISLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:3647 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4825
Mailing Address - Country:US
Mailing Address - Phone:843-559-5888
Mailing Address - Fax:843-559-3444
Practice Address - Street 1:3647 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4825
Practice Address - Country:US
Practice Address - Phone:843-559-5888
Practice Address - Fax:843-559-3444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARK SOUTH CAROLINA HOLDING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-06
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF1014Medicaid
425368Medicare Oscar/Certification