Healthcare Provider Details

I. General information

NPI: 1699368357
Provider Name (Legal Business Name): AVODAH HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2021
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 TWO NOTCH RD STE D
COLUMBIA SC
29223-6402
US

IV. Provider business mailing address

9320 TWO NOTCH RD STE D
COLUMBIA SC
29223-6402
US

V. Phone/Fax

Practice location:
  • Phone: 803-764-4048
  • Fax: 803-781-3292
Mailing address:
  • Phone: 803-955-1171
  • Fax: 803-781-3292

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: MRS. KATRECIA BELGRAVE
Title or Position: ADMINISTRATOR
Credential:
Phone: 803-240-6264