Organization
CONWAY MANOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND TILLER NHA (ADMINISTRATOR)
(843) 248-5728
Entity
Organization
Contact information
Practice address
3300 4TH AVE, CONWAY, SC 29527-6002
(843) 248-5728
(843) 248-6698
Mailing address
3300 4TH AVE, CONWAY, SC 29527-6002
(843) 248-5728
(843) 248-6698
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCF-899
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0899NF
—
SC
Enumeration date
05/22/2006
Last updated
01/11/2010
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