Provider Demographics
NPI:1194151670
Name:SEASHAR, LLC
Entity type:Organization
Organization Name:SEASHAR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:GUNRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-794-7561
Mailing Address - Street 1:2306 FORREST ST
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-2124
Mailing Address - Country:US
Mailing Address - Phone:803-794-7561
Mailing Address - Fax:
Practice Address - Street 1:2306 FORREST ST
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-2124
Practice Address - Country:US
Practice Address - Phone:803-794-7561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-1210310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCRC-1210OtherDHEC