Healthcare Provider Details

I. General information

NPI: 1972796670
Provider Name (Legal Business Name): TRI-CITY DIABETIC HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178A SAVANNAH HWY SUITE G
CHARLESTON SC
29414-5345
US

IV. Provider business mailing address

2178A SAVANNAH HWY
CHARLESTON SC
29414-5345
US

V. Phone/Fax

Practice location:
  • Phone: 843-266-0027
  • Fax: 843-266-0030
Mailing address:
  • Phone: 843-266-0027
  • Fax: 843-266-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RONALD BRADSHAW
Title or Position: OWNER
Credential:
Phone: 843-266-0027