Healthcare Provider Details

I. General information

NPI: 1740934645
Provider Name (Legal Business Name): BEACON HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 MCCLAM RD
CADES SC
29518-3302
US

IV. Provider business mailing address

392 MCCLAM RD
CADES SC
29518-3302
US

V. Phone/Fax

Practice location:
  • Phone: 843-382-3052
  • Fax: 843-382-3053
Mailing address:
  • Phone: 843-382-3052
  • Fax: 843-382-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. SHAFARA DOZIER DOUGLAS
Title or Position: OWNER
Credential: PA-C
Phone: 843-382-3052