| NPI | 1811428030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE LARISSA OVERTON Nurse Practitioner 803-429-7716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: SC 19829) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |