MEDICARE: IN-HOME COMPASSIONATE CARE SERVICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	HC3913	NC
2	385H00000X	Respite Care	IHCP-0762	SC
3	385H00000X	Respite Care	HC3913	NC
4	253Z00000X	In Home Supportive Care Agency	IHCP-0762	SC

General Provider Information

NPI Number	:	1134633381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN-HOME COMPASSIONATE CARE SERVICE, INC.

Provider Business Mailing Address
First Line	:	3009 CHURCH ST STE A
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5983
Country	:	US
Telephone Number	:	843-249-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3009 CHURCH ST STE A
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5983
Country	:	US
Telephone Number	:	843-249-9200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL KANE
Credential	:
Telephone Number	:	843-998-4883

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	03/17/2018

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