Healthcare Provider Details

I. General information

NPI: 1255399747
Provider Name (Legal Business Name): GEORGETOWN HOSPITAL HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/20/2023
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N LONGSTREET ST
KINGSTREE SC
29556-3301
US

IV. Provider business mailing address

3854 AMERICAN WAY SUITE A
BATON ROUGE LA
70816-4013
US

V. Phone/Fax

Practice location:
  • Phone: 843-355-5103
  • Fax: 866-882-9488
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA-188
License Number StateSC

VIII. Authorized Official

Name: MR. TRAVIS MIGLICCO
Title or Position: VP TAX
Credential:
Phone: 225-292-2031