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Organization
CHP TEGA CAY SC TENANT CORP
Active
Organization
CHP TEGA CAY SC TENANT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN R MADDRON (SR VICE PRESIDENT)
(407) 540-7652
Entity
Organization
Contact information
Practice address
111 WELLMORE DR, TEGA CAY, SC 29708-0039
(803) 835-7000
Mailing address
450 S ORANGE AVE, ORLANDO, FL 32801-3383
(407) 540-7652
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
NCF-0964
SC
314000000X
Skilled Nursing Facility
Primary
NCF-0964
SC
Other
Enumeration date
08/03/2015
Last updated
11/04/2016
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