Organization
LAURELCREST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAM BIDENAGEL RN (DIRECTOR OF REHAB)
(864) 544-2323
Entity
Organization
Contact information
Practice address
100 JOSEPH WALKER DR, WEST COLUMBIA, SC 29169-6971
(803) 796-0370
Mailing address
34 WOODCROSS DR APT 1203, COLUMBIA, SC 29212-2365
(803) 719-2206
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
2310
SC
Other
Enumeration date
04/11/2016
Last updated
04/11/2016
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