Healthcare Provider Details

I. General information

NPI: 1689912495
Provider Name (Legal Business Name): PROVIDENCE HOUSE CALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LAKESHORE PKWY
ROCK HILL SC
29730-4273
US

IV. Provider business mailing address

PO BOX 10984
ROCK HILL SC
29731-0984
US

V. Phone/Fax

Practice location:
  • Phone: 803-818-6955
  • Fax: 803-818-6993
Mailing address:
  • Phone: 844-628-2273
  • Fax: 803-372-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BETH TAYLOR
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 803-372-5884