Provider Demographics
NPI:1124115316
Name:THI OF SOUTH CAROLINA AT MAGNOLIA PLACE AT GREENVILLE, LLC
Entity type:Organization
Organization Name:THI OF SOUTH CAROLINA AT MAGNOLIA PLACE AT GREENVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:FARTHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-288-1415
Mailing Address - Street 1:35 SOUTHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5956
Mailing Address - Country:US
Mailing Address - Phone:864-288-1415
Mailing Address - Fax:
Practice Address - Street 1:35 SOUTHPOINTE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5956
Practice Address - Country:US
Practice Address - Phone:864-288-1415
Practice Address - Fax:864-288-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0869NFMedicaid
SC0869NFMedicaid