Healthcare Provider Details

I. General information

NPI: 1669780623
Provider Name (Legal Business Name): ANGELAS HOSPICE OF SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 10/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9570 TWO NOTCH RD
COLUMBIA SC
29223-4308
US

IV. Provider business mailing address

7001 SAINT ANDREWS RD # 342
COLUMBIA SC
29212-1137
US

V. Phone/Fax

Practice location:
  • Phone: 888-820-5305
  • Fax: 888-820-5305
Mailing address:
  • Phone: 888-820-5305
  • Fax: 888-820-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number94460
License Number StateSC

VIII. Authorized Official

Name: ANGELA S YOUNGBLOOD
Title or Position: CEO/OWNER
Credential: RN
Phone: 888-820-5305