Basic Information
Provider Information | |||||||||
NPI: | 1417269580 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | REDEEMER HEALTH & REHAB OF PICKENS, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 895 | ||||||||
Address2: |   | ||||||||
City: | PICKENS | ||||||||
State: | SC | ||||||||
PostalCode: | 296710895 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8648789620 | ||||||||
FaxNumber: | 8648782563 | ||||||||
Practice Location | |||||||||
Address1: | 138 ROSEMOND ST | ||||||||
Address2: |   | ||||||||
City: | PICKENS | ||||||||
State: | SC | ||||||||
PostalCode: | 296712434 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8648789620 | ||||||||
FaxNumber: | 8648782563 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/06/2010 | ||||||||
LastUpdateDate: | 04/13/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MURPHY | ||||||||
AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 9019377994 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | ARK SOUTH CAROLINA HOLDING COMPANY, LLC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X |   |   | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
ID Information
ID | Type | State | Issuer | Description | NF1022 | 05 | SC |   | MEDICAID |