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GOOSE CREEK MANOR
NPI 1679050868
Assisted Living Facility in Goose Creek, SC

Active since July 20, 2018CLIA 42D2029976 · Waiver
104 MARILYN ST, GOOSE CREEK, SC 29445(843) 572-7442(843) 553-4043 Get Directions Write a Review

NPPES record last updated: April 7, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 7, 2023, Jul 20, 2018 (2 updates tracked since 2018).

About Goose Creek Manor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GOOSE CREEK MANOR (NPI 1679050868) is a healthcare organization registered as an assisted living facility in Goose Creek, South Carolina and active in the NPI registry since July 2018. The organization holds a CLIA Waiver certificate valid through September 19, 2027 and lists Fuzail A Rizvi, President, as its authorized official.

NPPES Registry Identity

NPI1679050868
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSTAR CAPITAL INC
Location Address104 MARILYN STGoose Creek, SC 29445-3104
Mailing Address104 Marilyn StGoose Creek, SC 29445-3104 · (843) 572-7442 · Fax (843) 553-4043
Phone(843) 572-7442
Fax(843) 553-4043
Organization SubpartNo
Authorized OfficialFuzail A RizviPresident · (571) 225-8735
Enumeration DateJuly 20, 2018
Last NPPES UpdateApril 7, 20232 updates tracked since enumeration
NPPES CertifiedApril 7, 2023
✔ NPI 1679050868 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Licenses✔ Licensed in SC · CRC-2028✔ Licensed in SC · CRC-2027
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
104 MARILYN ST, Goose Creek, SC 29445
Open in Google Maps ↗

Other Names 1

Doing Business AsGoose Creek Manor

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 42D2029976

Goose Creek Manor (assisted Living Facility) · Goose Creek, SC
Active · expires Sep 19, 2027
CLIA Number42D2029976
Laboratory TypeAssisted Living Facility
Certificate Effective DateSeptember 20, 2025
Certificate Expiration DateSeptember 19, 2027
Laboratory DirectorLeticia G. De Dios
Laboratory Phone(843) 572-7442
Laboratory LocationGoose Creek Manor (assisted Living Facility)104 Marilyn St, Goose Creek, SC 29445
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NL & JR INCORPORATED
Assisted Living Facility
104 MARILYN ST
GOOSE CREEK, SC 29445
Berkeley County (843) 572-7442

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Star Capital Inc's NPI number?

The NPI number for Star Capital Inc is 1679050868. It was assigned to this organization in the NPPES registry on July 20, 2018. The provider is doing business as Goose Creek Manor.

Where is Star Capital Inc located?

Star Capital Inc is located at 104 Marilyn St, Goose Creek, SC 29445. The listed phone number is (843) 572-7442.

What is Star Capital Inc's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Star Capital Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 42D2029976) is associated with this NPI, valid through September 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Star Capital Inc was last updated on April 7, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.