Basic Information
| Provider Information | |||||||||
| NPI: | 1861962201 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SC-GA2018 SOUTHERN OAKS REHABILITATION AND HEALTHCARE CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHERN OAKS REHABILITATION AND HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 LOWNDES HILL ROAD | ||||||||
| Address2: | BLDG. 2, SUITE 101 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8646883992 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 109 BENTZ RD | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296731412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648455177 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2018 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | PALEY | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9143904363 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SC-GA OPERATOR HOLDINGS, INC. | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.