Healthcare Provider Details

I. General information

NPI: 1376164095
Provider Name (Legal Business Name): J.R. HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RICE BENT WAY STE 2B
COLUMBIA SC
29229-6850
US

IV. Provider business mailing address

259 MEADOW SPRINGS DR
COLUMBIA SC
29229-6891
US

V. Phone/Fax

Practice location:
  • Phone: 803-832-2141
  • Fax:
Mailing address:
  • Phone: 803-832-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA MARIE WILLIAMS
Title or Position: DIRECTOR
Credential: RN
Phone: 803-832-2141