Provider Demographics
NPI:1699784355
Name:ABBEVILLE NURSING HOME, INC.
Entity type:Organization
Organization Name:ABBEVILLE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-366-5122
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:83 THOMSON CIRCLE
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-0190
Mailing Address - Country:US
Mailing Address - Phone:864-366-5122
Mailing Address - Fax:864-366-6123
Practice Address - Street 1:83 THOMSON CIRCLE
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-0190
Practice Address - Country:US
Practice Address - Phone:864-366-5122
Practice Address - Fax:864-366-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-266314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC330090Medicaid
SC42-5057Medicare ID - Type Unspecified