| NPI | 1215932405 |
|---|---|
| Doing Business As | PROVIDENCE NORTHEAST TCU |
| Entity Type | Organization |
| Authorized Contact | JUDITH ANN KARAM President And CEO 803-256-5313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: SC 593N98) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-08-22 |