Healthcare Provider Details

I. General information

NPI: 1477319606
Provider Name (Legal Business Name): LIFETIME HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 07/24/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAIN STREET COLUMBIA, SC 29201 501
COLUMBIA SC
29201
US

IV. Provider business mailing address

1501 MAIN ST COLUMBIA, SC 29201 501
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-233-2221
  • Fax:
Mailing address:
  • Phone: 305-528-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HORACE KEARSE
Title or Position: OWNER
Credential:
Phone: 803-233-2221