Healthcare Provider Details

I. General information

NPI: 1952215477
Provider Name (Legal Business Name): NIRVANA DREAMS HEALTHCARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 LEE AVE
HAMPTON SC
29924-3441
US

IV. Provider business mailing address

PO BOX 112
HAMPTON SC
29924-0112
US

V. Phone/Fax

Practice location:
  • Phone: 803-403-9048
  • Fax: 803-902-6588
Mailing address:
  • Phone: 803-403-9048
  • Fax: 803-902-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TELETHA LUSHAY RUTH
Title or Position: OWNER/MANAGING MEMBER
Credential: DNP, CRNA, APRN
Phone: 803-403-9048