Healthcare Provider Details

I. General information

NPI: 1962547406
Provider Name (Legal Business Name): ADDUS HEALTHCARE (SOUTH CAROLINA), INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 BOONE TRL
NORTH WILKESBORO NC
28659-3515
US

IV. Provider business mailing address

801 WARRENVILLE RD STE 800
LISLE IL
60532-0912
US

V. Phone/Fax

Practice location:
  • Phone: 336-667-2208
  • Fax:
Mailing address:
  • Phone: 630-296-3400
  • Fax: 630-487-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DARBY ANDERSON
Title or Position: EVP CGRO
Credential:
Phone: 630-296-3443