Basic Information
| Provider Information | |||||||||
| NPI: | 1598076267 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSANNA HEALTH & REHAB OF PIEDMONT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 BENTZ RD | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296731412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648455177 | ||||||||
| FaxNumber: | 8648455258 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 BENTZ RD | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296731412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648455177 | ||||||||
| FaxNumber: | 8648455258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2010 | ||||||||
| LastUpdateDate: | 04/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9019377994 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ARK SOUTH CAROLINA HOLDING COMPANY, LLC | ||||||||
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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 | NF1013 | 05 | SC | MEDICAID |