Basic Information
| Provider Information | |||||||||
| NPI: | 1316313810 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FC MIDLANDS YORK, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CAROLINA GARDENS AT YORK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 LENOX ROAD | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707549660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 40 ROSS CANNON STREET | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036840183 | ||||||||
| FaxNumber: | 8038189080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2015 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7707549660 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.