Healthcare Provider Details

I. General information

NPI: 1730124363
Provider Name (Legal Business Name): CONGAREE HOME MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 STATE ST
CAYCE SC
29033-4344
US

IV. Provider business mailing address

1307 STATE ST
CAYCE SC
29033-4344
US

V. Phone/Fax

Practice location:
  • Phone: 803-939-0086
  • Fax: 803-939-0073
Mailing address:
  • Phone: 803-939-0086
  • Fax: 803-939-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNONE REQUIRED IN SC
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number65004626
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberNOT REQUIRED IN SC
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberNOT REQUIRED IN SC
License Number StateSC

VIII. Authorized Official

Name: MRS. CHERYL W. PHILLIPS
Title or Position: V. PRES
Credential:
Phone: 803-939-0086