Healthcare Provider Details

I. General information

NPI: 1497290852
Provider Name (Legal Business Name): CAROLINA ROSES OF BLYTHEWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONG POINTE LN STE 220-T
COLUMBIA SC
29229-7543
US

IV. Provider business mailing address

PO BOX 942
ELGIN SC
29045-0942
US

V. Phone/Fax

Practice location:
  • Phone: 803-397-1937
  • Fax: 803-735-8112
Mailing address:
  • Phone:
  • 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 Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number123598
License Number StateSC

VIII. Authorized Official

Name: SABREEN JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 803-397-1937