Healthcare Provider Details

I. General information

NPI: 1053834382
Provider Name (Legal Business Name): HSSC HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WOODS LAKE RD STE 408
GREENVILLE SC
29607-2763
US

IV. Provider business mailing address

PO BOX 26534
GREENVILLE SC
29616-1534
US

V. Phone/Fax

Practice location:
  • Phone: 864-979-0846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberIHCP-0652
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberIHCP-0652
License Number StateSC

VIII. Authorized Official

Name: TRACIE BLUE
Title or Position: CEO
Credential:
Phone: 864-979-0846