Provider Demographics
NPI:1730174335
Name:ELLEN SAGAR NURSING HOME
Entity type:Organization
Organization Name:ELLEN SAGAR NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:O
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-466-0350
Mailing Address - Street 1:1817 JONESVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-9793
Mailing Address - Country:US
Mailing Address - Phone:864-466-0350
Mailing Address - Fax:864-427-2666
Practice Address - Street 1:1817 JONESVILLE HWY
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-9793
Practice Address - Country:US
Practice Address - Phone:864-466-0350
Practice Address - Fax:864-427-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC164704Medicaid
SC164704Medicaid
SC0344470001Medicare NSC