Healthcare Provider Details

I. General information

NPI: 1932039278
Provider Name (Legal Business Name): DIANE'S AGE IN PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 BUSH RIVER RD STE 215C
COLUMBIA SC
29210-7537
US

IV. Provider business mailing address

652 BUSH RIVER RD STE 215C
COLUMBIA SC
29210-7537
US

V. Phone/Fax

Practice location:
  • Phone: 917-324-2396
  • Fax:
Mailing address:
  • Phone: 917-324-2396
  • Fax: 917-324-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE WOODARD
Title or Position: OWNER/DIRECTOR
Credential: WOODARD
Phone: 917-324-2396