Provider Demographics
NPI:1215932405
Name:PROVIDENCE HOSPITAL NORTHEAST TRANSITIONAL CARE UNIT
Entity type:Organization
Organization Name:PROVIDENCE HOSPITAL NORTHEAST TRANSITIONAL CARE UNIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KARAM
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:803-256-5313
Mailing Address - Street 1:2435 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2026
Mailing Address - Country:US
Mailing Address - Phone:803-256-5300
Mailing Address - Fax:803-256-5935
Practice Address - Street 1:120 GATEWAY CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9802
Practice Address - Country:US
Practice Address - Phone:803-865-4500
Practice Address - Fax:803-865-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC593N98314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC425350Medicare ID - Type UnspecifiedTCU