Healthcare Provider Details

I. General information

NPI: 1861489544
Provider Name (Legal Business Name): LORIS / CONWAY HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 WACCAMAW MEDICAL PARK CT
CONWAY SC
29526-8965
US

IV. Provider business mailing address

176 WACCAMAW MEDICAL PARK CT
CONWAY SC
29526-8965
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-5899
  • Fax: 843-357-5885
Mailing address:
  • Phone: 843-347-5899
  • Fax: 843-357-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA-155
License Number StateSC

VIII. Authorized Official

Name: DIANA L RUSSELL
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 843-347-5899