Healthcare Provider Details

I. General information

NPI: 1679936520
Provider Name (Legal Business Name): COMPLETE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SUMMER VIEW RD
SUMMERVILLE SC
29486-8369
US

IV. Provider business mailing address

204 SUMMER VIEW RD
SUMMERVILLE SC
29486-8369
US

V. Phone/Fax

Practice location:
  • Phone: 631-921-5886
  • Fax: 843-872-0527
Mailing address:
  • Phone: 631-921-5886
  • Fax: 843-872-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number32189
License Number StateSC

VIII. Authorized Official

Name: LAURA JEAN BAILEY
Title or Position: OWNER
Credential:
Phone: 631-921-5886