Healthcare Provider Details

I. General information

NPI: 1487001616
Provider Name (Legal Business Name): TRI-COUNTY CHOICE HOSPICE AND PALLIATIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 KNIGHT CIR
CLEMSON SC
29631-2113
US

IV. Provider business mailing address

115 KNIGHT CIR
CLEMSON SC
29631-2113
US

V. Phone/Fax

Practice location:
  • Phone: 864-653-5468
  • Fax:
Mailing address:
  • Phone: 864-653-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number212431
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number212431
License Number StateSC

VIII. Authorized Official

Name: CONSTANCIO K NAKUMA
Title or Position: CO-OWNER/MANAGER
Credential: PHD, MBA
Phone: 864-653-5468