Healthcare Provider Details

I. General information

NPI: 1467373985
Provider Name (Legal Business Name): CAREBUDDY UPSTATE SC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 RIVER CROSSING DRIVE STE 505
FORT MILL SC
29715
US

IV. Provider business mailing address

885 GOLD HILL RD
FORT MILL SC
29708-7946
US

V. Phone/Fax

Practice location:
  • Phone: 704-690-1015
  • Fax:
Mailing address:
  • Phone: 704-690-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: MYRA JEVON GOOD
Title or Position: PRINCIPAL
Credential:
Phone: 704-293-4289