Basic Information
| Provider Information | |||||||||
| NPI: | 1366492118 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANNE MARIA REHAB AND NURSING CTR | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANNE MARIA, INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 TALISMAN DR | ||||||||
| Address2: | |||||||||
| City: | NORTH AUGUSTA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298414032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032780011 | ||||||||
| FaxNumber: | 8034429344 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 TALISMAN DR | ||||||||
| Address2: | |||||||||
| City: | NORTH AUGUSTA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298414032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032780011 | ||||||||
| FaxNumber: | 8034429344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 02/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | GINN | ||||||||
| AuthorizedOfficialFirstName: | NOTA | ||||||||
| AuthorizedOfficialMiddleName: | FELTHAM | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8032780011 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NCF721 | SC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | V509P5189 | 01 | SC | VA CONTRACT PROVIDER | OTHER | V543NH | 05 | SC | MEDICAID | 0543NH | 05 | SC | MEDICAID |