Healthcare Provider Details

I. General information

NPI: 1104773472
Provider Name (Legal Business Name): AFFECTIONATELY DEVOTED HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 N OAK ST STE 205F
MYRTLE BEACH SC
29577-3164
US

IV. Provider business mailing address

2411 N OAK ST STE 205F
MYRTLE BEACH SC
29577-3164
US

V. Phone/Fax

Practice location:
  • Phone: 888-304-2344
  • Fax: 888-304-2344
Mailing address:
  • Phone: 888-304-2344
  • Fax: 888-304-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: SHANYEL GIBSON
Title or Position: CEO
Credential:
Phone: 888-304-2344