Healthcare Provider Details

I. General information

NPI: 1306165220
Provider Name (Legal Business Name): AHAVA HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 IRMO DR
COLUMBIA SC
29212-8637
US

IV. Provider business mailing address

7505 IRMO DRIVE
COLUMBIA SC
29212
US

V. Phone/Fax

Practice location:
  • Phone: 803-794-3269
  • Fax: 803-791-1634
Mailing address:
  • Phone: 803-794-3269
  • Fax: 803-791-1634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHARLES E SLOAN JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 803-794-3269