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General NPI Number Information
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NPI Number | 1407221401
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Entity Type | Organization
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Legal Business Name | CAPITAL CARE RESOURCES OF SOUTH CAROLINA, LLC
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 415 ROBERTSON BLVD STE E
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City | WALTERBORO
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State | SC
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Zip | 29488-5713
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Country | US
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Telephone | 843-542-9540
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Fax |
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Provider Business Mailing Address
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Address Line | 6330 SPRINT PKWY STE 300
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1157
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED SIGNATORY
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Name | JOHN NICHOLS
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Credential |
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Telephone | 843-542-9540
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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-0011
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License Number State | SC
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