Willow Creek Living Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCF-682 Issued in SC

Legal business name

WILLOW CREEK LIVING CENTER, LLC

Practice address

406 West Broad Street
Iva, SC 29655

Phone

(864) 348-7433

Fax

(864) 348-3888

NPI assigned

Jul 17, 2006

Last updated

Mar 10, 2008By 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

Mr. John F. Swift

Title

VP & Cfo

Phone

(864) 269-3725

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205107200000",
    "number": "1740208776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 GRACE DR",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296409088",
            "telephone_number": "864-269-3725",
            "fax_number": "864-295-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 WEST BROAD STREET",
            "city": "IVA",
            "state": "SC",
            "postal_code": "29655",
            "telephone_number": "864-348-7433",
            "fax_number": "864-348-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK LIVING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2008-03-10",
        "status": "A",
        "authorized_official_last_name": "SWIFT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "VP & CFO",
        "authorized_official_telephone_number": "864-269-3725",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SC",
            "license": "NCF-682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0682 NF",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• SC-Ga2018 Iva Rehabilitation and Healthcare Center, LLC (Iva Rehabilitation and Healthcare Center)
• Shawntea N Scott
• Becky Shank, L.I.S.W
• Mikell Stevenson, PHARMD
• Annabeth Watkins, PT

• Skilled Nursing Facility in Iva, SC
• Providers in Iva, 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 Mar 10, 2008; 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.