Provider Demographics
NPI:1821818329
Name:SOUTHSIDE MANOR RESIDENTIAL CARE FAILITY
Entity type:Organization
Organization Name:SOUTHSIDE MANOR RESIDENTIAL CARE FAILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-883-4066
Mailing Address - Street 1:311 MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-5742
Mailing Address - Country:US
Mailing Address - Phone:803-883-4066
Mailing Address - Fax:803-778-5917
Practice Address - Street 1:311 MANNING AVE
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-5742
Practice Address - Country:US
Practice Address - Phone:803-883-4066
Practice Address - Fax:803-778-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility