Basic Information
| Provider Information | |||||||||
| NPI: | 1164472122 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARVEYS NURSING LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARVEYS INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 LOVE AND CARE RD | ||||||||
| Address2: | |||||||||
| City: | SIX MILE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296829569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648682307 | ||||||||
| FaxNumber: | 8648687813 | ||||||||
| Practice Location | |||||||||
| Address1: | 163 LOVE AND CARE RD | ||||||||
| Address2: | |||||||||
| City: | SIX MILE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296829569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648682307 | ||||||||
| FaxNumber: | 8648687813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GINN | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATIONS OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8032780011 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | NHA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NCF580 | SC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0580NH | 05 | SC | MEDICAID |