Healthcare Provider Details

I. General information

NPI: 1194180539
Provider Name (Legal Business Name): SOUTHEASTERN COMMUNITY DEVELOPMENT HOME HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 CENTER ST
WEST COLUMBIA SC
29169-6749
US

IV. Provider business mailing address

1053 CENTER ST
WEST COLUMBIA SC
29169-6749
US

V. Phone/Fax

Practice location:
  • Phone: 803-451-6500
  • Fax: 803-454-0371
Mailing address:
  • Phone: 803-451-6500
  • Fax: 803-454-0371

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGETTE WARD
Title or Position: DIRECTOR
Credential: PH.D
Phone: 803-451-6500