Healthcare Provider Details

I. General information

NPI: 1902099161
Provider Name (Legal Business Name): HEALTHCARE ETC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 PARKLANE RD STE 101
COLUMBIA SC
29223-7644
US

IV. Provider business mailing address

7340 PARKLANE RD STE 101
COLUMBIA SC
29223-7644
US

V. Phone/Fax

Practice location:
  • Phone: 803-708-4750
  • Fax: 803-753-0160
Mailing address:
  • Phone: 803-708-4750
  • Fax: 803-753-0160

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: VALARIE SQUIREWELL
Title or Position: PARTNER
Credential:
Phone: 803-708-4750