Organization
WILLISTON HEALTHCARE AND REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAIM CY PIZAM (MANAGING MEMBER)
(407) 454-9096
Entity
Organization
Contact information
Practice address
5721 SPRINGFIELD RD, WILLISTON, SC 29853-1917
(803) 266-3229
Mailing address
5721 SPRINGFIELD RD, WILLISTON, SC 29853-1917
(803) 266-3229
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH-754
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0754NF
—
SC
01
—
NCF-1037
DHEC LIC #
SC
Enumeration date
10/07/2005
Last updated
10/17/2019
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