Healthcare Provider Details

I. General information

NPI: 1023322583
Provider Name (Legal Business Name): ADDUS HEALTHCARE (SOUTH CAROLINA), INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 15TH ST SUITE 1
AUGUSTA GA
30901-3158
US

IV. Provider business mailing address

2401 S PLUM GROVE RD
PALATINE IL
60067-7486
US

V. Phone/Fax

Practice location:
  • Phone: 866-806-6331
  • Fax: 706-774-0007
Mailing address:
  • Phone: 847-303-5300
  • Fax: 847-303-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE KUMARICH
Title or Position: NATIONAL CONTRACTS
Credential: RN, MS, MBA
Phone: 847-303-5300