Provider Demographics
NPI:1609044338
Name:LOWCOUNTRY NURSING GROUP
Entity type:Organization
Organization Name:LOWCOUNTRY NURSING GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTHCARE/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANZO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-569-5510
Mailing Address - Street 1:17 SHERINGTON DR
Mailing Address - Street 2:UNIT B-1
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6032
Mailing Address - Country:US
Mailing Address - Phone:843-757-5655
Mailing Address - Fax:
Practice Address - Street 1:17 SHERINGTON DR
Practice Address - Street 2:UNIT B-1
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6032
Practice Address - Country:US
Practice Address - Phone:843-757-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0795Medicaid