Healthcare Provider Details

I. General information

NPI: 1487580858
Provider Name (Legal Business Name): ROSE LEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 CLAIRBORNE PL
COLUMBIA SC
29229-7796
US

IV. Provider business mailing address

616 CHILHOWIE RD
COLUMBIA SC
29209-5524
US

V. Phone/Fax

Practice location:
  • Phone: 803-795-2559
  • Fax:
Mailing address:
  • Phone: 254-669-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number15112379
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: