Healthcare Provider Details

I. General information

NPI: 1780461517
Provider Name (Legal Business Name): XTREME HOME CARE OF THE UPSTATE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 ANDERSON ST STE B
BELTON SC
29627-2148
US

IV. Provider business mailing address

PO BOX 479
BELTON SC
29627-0479
US

V. Phone/Fax

Practice location:
  • Phone: 864-276-6525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID FIELDS
Title or Position: CO-OWNER
Credential:
Phone: 864-276-6525