Healthcare Provider Details

I. General information

NPI: 1285566612
Provider Name (Legal Business Name): JUDAH MED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ASHLAND PARK LN STE B
COLUMBIA SC
29210-5100
US

IV. Provider business mailing address

100 ASHLAND PARK LN STE B
COLUMBIA SC
29210-5100
US

V. Phone/Fax

Practice location:
  • Phone: 803-233-7554
  • Fax:
Mailing address:
  • Phone: 803-233-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LATEYA DAISY SMITH
Title or Position: OWNER/ADMIN
Credential:
Phone: 803-233-7554