Healthcare Provider Details

I. General information

NPI: 1245012384
Provider Name (Legal Business Name): SWING CARE PROVIDER GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 FABER PLACE DR STE 300
NORTH CHARLESTON SC
29405-8587
US

IV. Provider business mailing address

440 N BARRANCA AVE # 1801
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 262-667-7326
  • Fax: 877-349-1868
Mailing address:
  • Phone: 800-924-7811
  • Fax: 877-349-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEREMY FRANK
Title or Position: HEAD OF OPERATIONS
Credential:
Phone: 415-602-0855