Club Horizons of Charleston, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

ADC-0418 Issued in SC

Legal business name

CLUB HORIZONS OF CHARLESTON, LLC

Practice address

8088 Rivers Ave
North Charleston, SC 29406-9235

Phone

(843) 992-2432

NPI assigned

Jun 27, 2017

Last updated

Jun 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Ann Sparks Belissary, M.ED.

Title

Administrator

Phone

(843) 992-2432

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1265953590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 COURTHOUSE SQ",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295013432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8088 RIVERS AVE",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069235",
            "telephone_number": "843-992-2432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB HORIZONS OF CHARLESTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-27",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "BELISSARY",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "SPARKS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "843-992-2432",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.ED."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "SC",
            "license": "ADC-0418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in North Charleston, SC
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.