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General NPI Number Information
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NPI Number | 1174540140
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Entity Type | Organization
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Legal Business Name | STATE OF SOUTH CAROLINA
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 220 MCGEE RD
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City | ANDERSON
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State | SC
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Zip | 29625-2104
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Country | US
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Telephone | 864-260-5601
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Fax | 866-310-7688
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Provider Business Mailing Address
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Address Line | 220 MCGEE RD
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City | ANDERSON
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State | SC
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Zip | 29625-2104
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Country | US
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Telephone | 864-260-5601
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Fax | 866-310-7688
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Authorized Official
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Title or Position | DIRECTOR/HOME HEALTH ADMINISTRATOR
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Name | MR. LEE A KIRKPATRICK
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Credential | LMSW
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Telephone | 803-576-2916
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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 | HHA-001
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License Number State | SC
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