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Organization
LAKE WYLIE
Active
Organization
LAKE WYLIE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON HARDER (PRESIDENT)
(503) 486-8697
Entity
Organization
Contact information
Practice address
4877 CHARLOTTE HIGHWAY, LAKE WYLIE, SC 29710
(803) 831-9900
Mailing address
PO BOX 3006, SALEM, OR 97302
(503) 485-8697
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
NULL
Other
Enumeration date
05/02/2007
Last updated
08/22/2020
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