Healthcare Provider Details

I. General information

NPI: 1104098581
Provider Name (Legal Business Name): MS. ELIZABETH ADAMS CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SUMMIT DRIVE 12D
GREENVILLE SC
29609
US

IV. Provider business mailing address

400 SUMMIT DRIVE 12D
GREENVILLE SC
29609
US

V. Phone/Fax

Practice location:
  • Phone: 864-298-0053
  • Fax:
Mailing address:
  • Phone: 864-298-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number112788R
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: