Healthcare Provider Details

I. General information

NPI: 1003779265
Provider Name (Legal Business Name): TRADITIONAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 W EVANS ST STE 1
FLORENCE SC
29501-3317
US

IV. Provider business mailing address

1007 W EVANS ST STE 1
FLORENCE SC
29501-3317
US

V. Phone/Fax

Practice location:
  • Phone: 843-788-9977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CAIRNS DESAI
Title or Position: OWNER
Credential:
Phone: 843-788-9977