Healthcare Provider Details

I. General information

NPI: 1710445499
Provider Name (Legal Business Name): MRS. TOMEKA GRATE-TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 01/20/2022
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SUMMIT TERRACE CT
COLUMBIA SC
29229-7055
US

IV. Provider business mailing address

425 SUMMIT TERRACE CT STE 1A
COLUMBIA SC
29229-7056
US

V. Phone/Fax

Practice location:
  • Phone: 803-939-6147
  • Fax: 803-939-6148
Mailing address:
  • Phone: 803-939-6147
  • Fax: 803-939-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberEX1794
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: