MEDICARE: GEORGETOWN HOSPITAL HOME HEALTH 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	251E00000X	Home Health Agency	HHA-187	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811955065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGETOWN HOSPITAL HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	3854 AMERICAN WAY STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4897
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	10607 HIGHWAY 707 UNIT 150
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-5555
Country	:	US
Telephone Number	:	843-916-0931
Fax Number	:	843-916-0985

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. JOSHUA PROFFITT
Credential	:
Telephone Number	:	617-639-4092

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	04/06/2026

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