Healthcare Provider Details

I. General information

NPI: 1134361470
Provider Name (Legal Business Name): AGAPE HOSPICE HOUSE OF HORRY COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 HIGHWAY 378
CONWAY SC
29527-4911
US

IV. Provider business mailing address

2320 HIGHWAY 378
CONWAY SC
29527-4911
US

V. Phone/Fax

Practice location:
  • Phone: 843-397-2273
  • Fax:
Mailing address:
  • Phone: 843-397-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License NumberHPC0522
License Number StateSC

VIII. Authorized Official

Name: MR. GREGORY SCOTT MIDDLETON
Title or Position: CEO
Credential:
Phone: 803-454-0365