Basic Information
Provider Information
NPI: 1679562078
EntityType: 2
ReplacementNPI:  
OrganizationName: BARNWELL COUNTY NURSING HOME
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 31 WREN ST
Address2: POST OFFICE BOX 807
City: BARNWELL
State: SC
PostalCode: 298121528
CountryCode: US
TelephoneNumber: 8032595547
FaxNumber: 8032597350
Practice Location
Address1: 31 WREN ST
Address2:  
City: BARNWELL
State: SC
PostalCode: 298121528
CountryCode: US
TelephoneNumber: 8032595547
FaxNumber: 8032597350
Other Information
ProviderEnumerationDate: 10/18/2005
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GAMBILL
AuthorizedOfficialFirstName: GERI
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ADMINISTRATOR
AuthorizedOfficialTelephone: 8032595547
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: RN, NHA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X SCY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
SC000601SCMDSOTHER
21247005SC MEDICAID


Home