Healthcare Provider Details

I. General information

NPI: 1023098712
Provider Name (Legal Business Name): HEDGEMARK BRENTWOOD MEDICAL SERVICES, INC.-DBA PHC HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 FOLLY ROAD
CHARLESTON SC
29412
US

IV. Provider business mailing address

1548 ASHLEY RIVER ROAD SUITE B
CHARLESTON SC
29407
US

V. Phone/Fax

Practice location:
  • Phone: 843-762-3601
  • Fax: 843-762-7074
Mailing address:
  • Phone: 843-762-3601
  • Fax: 843-762-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA-084
License Number StateSC

VIII. Authorized Official

Name: MRS. ELLEN S. DURRENCE
Title or Position: V-PRESIDENT
Credential: R.PH.
Phone: 843-762-3601