Healthcare Provider Details

I. General information

NPI: 1285903310
Provider Name (Legal Business Name): COMMUNITY PASTOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7356 GARNERS FERRY RD SUITE 125
COLUMBIA SC
29209-2146
US

IV. Provider business mailing address

7356 GARNERS FERRY RD SUITE 125
COLUMBIA SC
29209-2146
US

V. Phone/Fax

Practice location:
  • Phone: 803-834-5572
  • Fax:
Mailing address:
  • Phone: 803-834-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateSC

VIII. Authorized Official

Name: SAMMY WADE
Title or Position: CEO
Credential:
Phone: 803-834-5572