Provider Demographics
NPI:1770886186
Name:REFLECTIONS AT CAROLINA FOREST, INC.
Entity type:Organization
Organization Name:REFLECTIONS AT CAROLINA FOREST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:DEKALB
Authorized Official - Last Name:CLARDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRCFA
Authorized Official - Phone:843-903-0700
Mailing Address - Street 1:219 MIDDLEBURG DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3409
Mailing Address - Country:US
Mailing Address - Phone:843-903-0700
Mailing Address - Fax:843-903-0714
Practice Address - Street 1:219 MIDDLEBURG DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3409
Practice Address - Country:US
Practice Address - Phone:843-903-0700
Practice Address - Fax:843-903-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-1456310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility