Healthcare Provider Details

I. General information

NPI: 1376305607
Provider Name (Legal Business Name): SWAMP RABBIT HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SE MAIN ST STE 203
SIMPSONVILLE SC
29681-2696
US

IV. Provider business mailing address

405 MAYDEN CT
GREER SC
29651-8500
US

V. Phone/Fax

Practice location:
  • Phone: 864-498-9048
  • Fax:
Mailing address:
  • Phone: 864-498-9048
  • Fax:

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

VIII. Authorized Official

Name: WANDA DENISE PYLES
Title or Position: CEO
Credential:
Phone: 864-498-9048