Petra Health & Rehab of McCormick, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PETRA HEALTH & REHAB OF MCCORMICK, LLC

Practice address

204 Holiday Rd
MC Cormick, SC 29835-3429

Phone

(864) 391-2390

Fax

(864) 391-2397

NPI assigned

Jul 3, 2010

Last updated

Apr 13, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

ARK SOUTH CAROLINA HOLDING COMPANY, LLCAs reported in NPPES

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

Authorized official

Name

Christopher J Murphy

Title

Vice President

Phone

(901) 937-7994

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1278115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1699087841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 HOLIDAY RD",
            "city": "MC CORMICK",
            "state": "SC",
            "postal_code": "298353429",
            "telephone_number": "864-391-2390",
            "fax_number": "864-391-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 HOLIDAY RD",
            "city": "MC CORMICK",
            "state": "SC",
            "postal_code": "298353429",
            "telephone_number": "864-391-2390",
            "fax_number": "864-391-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRA HEALTH & REHAB OF MCCORMICK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARK SOUTH CAROLINA HOLDING COMPANY, LLC",
        "enumeration_date": "2010-07-03",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "901-937-7994"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NF1024",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in McCormick, SC
• Providers in McCormick, SC by specialty
• Skilled Nursing Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; 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.