Provider Demographics
NPI:1982470993
Name:PATRIOT LIVING OF FLORENCE, LLC
Entity Type:Organization
Organization Name:PATRIOT LIVING OF FLORENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-444-0082
Mailing Address - Street 1:22 TREYBURN CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3686
Mailing Address - Country:US
Mailing Address - Phone:864-444-0082
Mailing Address - Fax:888-356-3149
Practice Address - Street 1:739 S PARKER DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6062
Practice Address - Country:US
Practice Address - Phone:864-444-0082
Practice Address - Fax:888-356-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility