Healthcare Provider Details

I. General information

NPI: 1891756458
Provider Name (Legal Business Name): PORTSBRIDGE SOUTH CAROLINA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 HOSPITAL DR W
WEST COLUMBIA SC
29169-3405
US

IV. Provider business mailing address

1800 PHOENIX BLVD SUITE 128
ATLANTA GA
30349-5593
US

V. Phone/Fax

Practice location:
  • Phone: 803-939-2788
  • Fax: 803-939-4640
Mailing address:
  • Phone: 678-284-5850
  • Fax: 770-909-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHPC077
License Number StateSC

VIII. Authorized Official

Name: ANITA HOSSFELD
Title or Position: PRESIDENT
Credential: LMSW
Phone: 678-284-5856