Provider Demographics
NPI:1881691384
Name:RIDGELAND NURSING CENTER INC
Entity type:Organization
Organization Name:RIDGELAND NURSING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LTC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-726-5581
Mailing Address - Street 1:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2627
Mailing Address - Country:US
Mailing Address - Phone:843-726-5581
Mailing Address - Fax:843-726-3741
Practice Address - Street 1:1516 GRAYS HWY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-5440
Practice Address - Country:US
Practice Address - Phone:843-726-5581
Practice Address - Fax:843-726-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0553NHMedicaid
SC5152110001Medicare NSC
SC0553NHMedicaid