Provider Demographics
NPI:1265759971
Name:ROPER HOSPITAL INC
Entity type:Organization
Organization Name:ROPER HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-402-7000
Mailing Address - Street 1:8536 PALMETTO COMMERCE PKWY STE 207A
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6700
Mailing Address - Country:US
Mailing Address - Phone:843-402-7000
Mailing Address - Fax:843-769-6205
Practice Address - Street 1:8536 PALMETTO COMMERCE PKWY STE 207A
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-6700
Practice Address - Country:US
Practice Address - Phone:843-402-7000
Practice Address - Fax:843-769-6205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROPER HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-062251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC470421Medicaid