Provider Demographics
NPI:1902346273
Name:MAXIMUS SPARTANBURG, LLC
Entity Type:Organization
Organization Name:MAXIMUS SPARTANBURG, LLC
Other - Org Name:SKYLYN NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-220-2061
Mailing Address - Street 1:1705 SKYLYN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1077
Mailing Address - Country:US
Mailing Address - Phone:864-208-1844
Mailing Address - Fax:
Practice Address - Street 1:1705 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1077
Practice Address - Country:US
Practice Address - Phone:864-208-1844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-0700314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility