Organization
NL & JR INCORPORATED
Active
Other names
Goose Creek Manor
Organization subpart
No
Provider details
NPI number
Authorized official
LETICIA DEDIOS (ADMINISTRATOR)
(843) 572-7442
Entity
Organization
Contact information
Practice address
104 MARILYN ST, GOOSE CREEK, SC 29445-3104
(843) 572-7442
Mailing address
104 MARILYN ST, GOOSE CREEK, SC 29445-3104
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
CRC0639
SC
310400000X
Assisted Living Facility
Primary
CRC0762
SC
Other
Enumeration date
07/01/2013
Last updated
07/01/2013
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