Healthcare Provider Details

I. General information

NPI: 1073271441
Provider Name (Legal Business Name): MY FATHERS TOUCH IN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 DICKSON AVE STE 109
HANAHAN SC
29410-2853
US

IV. Provider business mailing address

1253 DICKSON AVE STE 109
HANAHAN SC
29410-2853
US

V. Phone/Fax

Practice location:
  • Phone: 843-779-4037
  • Fax: 843-608-7371
Mailing address:
  • Phone: 843-779-4037
  • Fax: 843-608-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MAVIS L MANIGAULT
Title or Position: OWNER
Credential: MEDICAL ASSISTANT
Phone: 843-530-2411