Healthcare Provider Details

I. General information

NPI: 1710983242
Provider Name (Legal Business Name): ISLAND HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NEW RIVER PKWY STE 7
HARDEEVILLE SC
29927-4575
US

IV. Provider business mailing address

PO BOX 8011
SAVANNAH GA
31412-8011
US

V. Phone/Fax

Practice location:
  • Phone: 912-629-2727
  • Fax:
Mailing address:
  • Phone: 912-629-2727
  • Fax: 912-234-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA111
License Number StateSC

VIII. Authorized Official

Name: MRS. ELLEN B BOLCH
Title or Position: PRESIDENT/CEO
Credential:
Phone: 912-629-2727