Healthcare Provider Details

I. General information

NPI: 1225132756
Provider Name (Legal Business Name): DYNAMIC HEALTH CARE SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HEYWARD ST SUITE - A
COLUMBIA SC
29201-4390
US

IV. Provider business mailing address

339 HEYWARD ST SUITE - A
COLUMBIA SC
29201-4390
US

V. Phone/Fax

Practice location:
  • Phone: 803-765-2247
  • Fax: 803-765-2280
Mailing address:
  • Phone: 803-765-2247
  • Fax: 803-765-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number42D1032607
License Number StateSC

VIII. Authorized Official

Name: MRS. THELMA ROBINSON
Title or Position: ADMINISTRATOR
Credential: RN, MSN
Phone: 248-379-7999