Quillen Manor LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

CRC-1321 Issued in SC

Legal business name

QUILLEN MANOR LLC

Practice address

709 Quillen Ave
Fountain Inn, SC 29644-9444

Phone

(864) 862-3252

Fax

(864) 862-3254

NPI assigned

Mar 15, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jerry Phillip Richmond

Title

Executive Director

Phone

(864) 862-3252

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1255655650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 QUILLEN AVE",
            "city": "FOUNTAIN INN",
            "state": "SC",
            "postal_code": "296449444",
            "telephone_number": "864-862-3252",
            "fax_number": "864-862-3254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 QUILLEN AVE",
            "city": "FOUNTAIN INN",
            "state": "SC",
            "postal_code": "296449444",
            "telephone_number": "864-862-3252",
            "fax_number": "864-862-3254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUILLEN MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-15",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "RICHMOND",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "PHILLIP",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "864-862-3252",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SC",
            "license": "CRC-1321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trela Rene Peters
• Christina M. Poole
• Taylor Price, COTA/L
• Prisma Health-Upstate (Prisma Health Primary Care Fountain Inn)
• Prisma Health-Upstate (Prisma Health Primary Care Fountain Inn)
• RCG University Division, Inc. (Fresenius Medical Care Fountain Inn - Gray Court)
• Reach and Rise Preschool
• Redefine Wellness Holistic Coaching, LLC
• Sarah Rivard, COTA/L
• Tricia Lynn Robinson, COTA/L

• Assisted Living Facility in Fountain Inn, SC
• Providers in Fountain Inn, SC by specialty
• Assisted Living Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.