Healthcare Provider Details

I. General information

NPI: 1639102783
Provider Name (Legal Business Name): CAROLINAS COMMUNITY HOSPICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 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: 803-454-0365
  • Fax:
Mailing address:
  • Phone: 803-454-0365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHSP061
License Number StateSC

VIII. Authorized Official

Name: MR. G. SCOTT MIDDLETON
Title or Position: PRESIDENT
Credential:
Phone: 803-454-3505