Healthcare Provider Details

I. General information

NPI: 1265733125
Provider Name (Legal Business Name): JASON KUPIEC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRUST SERVICES 5253 MULHOLLAND DRIVE
SUMMERVILLE SC
29485
US

IV. Provider business mailing address

5253 MULHOLLAND DR
SUMMERVILLE SC
29485-8077
US

V. Phone/Fax

Practice location:
  • Phone: 843-879-8892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number24513
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number24513
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number24513
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number24513
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: