Basic Information
| Provider Information | |||||||||
| NPI: | 1215932405 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROVIDENCE HOSPITAL NORTHEAST TRANSITIONAL CARE UNIT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PROVIDENCE NORTHEAST TCU | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2435 FOREST DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292042026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032565300 | ||||||||
| FaxNumber: | 8032565935 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 GATEWAY CORPORATE BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292039802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038654500 | ||||||||
| FaxNumber: | 8038654515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KARAM | ||||||||
| AuthorizedOfficialFirstName: | JUDITH | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8032565313 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CSA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 593N98 | SC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.