Healthcare Provider Details

I. General information

NPI: 1255126256
Provider Name (Legal Business Name): PHENOMENAL HOME HEALTH CARE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 TWO NOTCH RD # 41
COLUMBIA SC
29223-5850
US

IV. Provider business mailing address

9005 TWO NOTCH RD # 41
COLUMBIA SC
29223-5850
US

V. Phone/Fax

Practice location:
  • Phone: 803-638-4120
  • Fax:
Mailing address:
  • Phone: 803-638-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WARREN BAILEY
Title or Position: C.F.O.
Credential:
Phone: 803-638-4120