Healthcare Provider Details

I. General information

NPI: 1609796762
Provider Name (Legal Business Name): BERKELEY HOME CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 OLD HIGHWAY 52 STE E
MONCKS CORNER SC
29461-3011
US

IV. Provider business mailing address

1000 CHURCHILL RD
MONCKS CORNER SC
29461-7134
US

V. Phone/Fax

Practice location:
  • Phone: 843-830-8636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL MARIE BAILEY
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-C
Phone: 843-830-8636