MEDICARE: SANDHILLS HOME CARE LLC

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

General Provider Information

NPI Number	:	1750788386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDHILLS HOME CARE LLC

Provider Business Mailing Address
First Line	:	547 7 LKS N
Second Line	:
City	:	WEST END
State	:	NC
Zip	:	27376-9767
Country	:	US
Telephone Number	:	910-690-0582
Fax Number	:	910-215-8767

Provider Business Practice Location Address
First Line	:	2701 S OCEAN BLVD
Second Line	:	UNIT 1534
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-4641
Country	:	US
Telephone Number	:	910-690-0582
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. GREGORY DOUGLAS RICHARDSON
Credential	:
Telephone Number	:	910-690-0582

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	11/25/2014

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