Healthcare Provider Details

I. General information

NPI: 1467925255
Provider Name (Legal Business Name): HOMEWATCH CAREGIVERS OF ROCK HILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2342 EBENEZER RD STE A
ROCK HILL SC
29732-8256
US

IV. Provider business mailing address

PO BOX 37076
ROCK HILL SC
29732-0517
US

V. Phone/Fax

Practice location:
  • Phone: 803-752-4724
  • Fax: 803-752-4724
Mailing address:
  • Phone: 803-752-4724
  • Fax: 803-752-4724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: SHAWN SMITH
Title or Position: PRESIDENT
Credential:
Phone: 803-752-4724