Healthcare Provider Details

I. General information

NPI: 1942580089
Provider Name (Legal Business Name): ST. CHRISTOPHERS HOME CARE AGENCY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2011
Last Update Date: 08/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 TWO NOTCH RD SUITE 22
COLUMBIA SC
29223-5850
US

IV. Provider business mailing address

9005 TWO NOTCH RD SUITE 22
COLUMBIA SC
29223-5850
US

V. Phone/Fax

Practice location:
  • Phone: 803-419-5581
  • Fax: 803-419-5534
Mailing address:
  • Phone: 803-419-5581
  • Fax: 803-419-5534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care 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: DARLENE REAVES
Title or Position: ADMINISTRATOR
Credential:
Phone: 803-419-5581