Healthcare Provider Details

I. General information

NPI: 1942171848
Provider Name (Legal Business Name): NGL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 BUSH RIVER RD STE 211
COLUMBIA SC
29210-7537
US

IV. Provider business mailing address

652 BUSH RIVER RD STE 211
COLUMBIA SC
29210-7537
US

V. Phone/Fax

Practice location:
  • Phone: 803-400-8750
  • Fax:
Mailing address:
  • Phone: 803-400-8750
  • Fax:

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: NOLAN GRAHAM
Title or Position: PRESIDENT
Credential:
Phone: 803-400-8750