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General NPI Number Information
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NPI Number | 1093180721
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Entity Type | Individual
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Provider Name | MR. IAN R SANDERS
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Gender | Male
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 2788 SC HIGHWAY 37
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City | WILLISTON
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State | SC
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Zip | 29853-4429
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Country | US
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Telephone | 803-310-7560
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 671
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City | ALLENDALE
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State | SC
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Zip | 29810-0671
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Country | US
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Telephone | 803-716-0727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | SC
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