Organization
DHEC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE JACKSON (RN)
(843) 992-9132
Entity
Organization
Contact information
Practice address
319 STEPHEN CT, MULLINS, SC 29574-4223
(843) 992-9132
Mailing address
319 STEPHEN CT, MULLINS, SC 29574-4223
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
235692
SC
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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