Provider Demographics
NPI:1588093330
Name:SOUTHERN OAKS REHABILITATION AND HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:SOUTHERN OAKS REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-626-0000
Mailing Address - Street 1:109 BENTZ RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-1412
Mailing Address - Country:US
Mailing Address - Phone:864-845-5177
Mailing Address - Fax:864-845-5258
Practice Address - Street 1:109 BENTZ RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-1412
Practice Address - Country:US
Practice Address - Phone:864-845-5177
Practice Address - Fax:864-845-5258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORIANNA SC OPERATOR HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-02
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF1054Medicaid
425314Medicare Oscar/Certification