Provider Demographics
NPI:1194596882
Name:WILSON SENIOR CARE HONORAGE LLC
Entity type:Organization
Organization Name:WILSON SENIOR CARE HONORAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:WEESNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-395-8971
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29540-0510
Mailing Address - Country:US
Mailing Address - Phone:843-395-8971
Mailing Address - Fax:843-395-8972
Practice Address - Street 1:1207 N CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-6937
Practice Address - Country:US
Practice Address - Phone:843-395-8971
Practice Address - Fax:843-395-8972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON SENIOR CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-11
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility