Healthcare Provider Details

I. General information

NPI: 1154215762
Provider Name (Legal Business Name): HEAVENLY CARE OF THE CAROLINAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N CHURCH ST
UNION SC
29379-1653
US

IV. Provider business mailing address

924 N CHURCH ST
UNION SC
29379-1653
US

V. Phone/Fax

Practice location:
  • Phone: 864-414-9297
  • Fax: 864-424-9142
Mailing address:
  • Phone: 864-414-9297
  • Fax: 864-424-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LAURA ANN ROGERS
Title or Position: PRESEIDENT
Credential:
Phone: 864-414-9297