Healthcare Provider Details

I. General information

NPI: 1144150574
Provider Name (Legal Business Name): LAKESHORE PALLIATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HERLONG AVE S
ROCK HILL SC
29732-1158
US

IV. Provider business mailing address

6650 RIVERS AVE STE 100
NORTH CHARLESTON SC
29406-4809
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-1234
  • Fax:
Mailing address:
  • Phone: 864-870-4505
  • 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: BRANDI MOSLEY GRIFFIN
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 803-322-8691