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General NPI Number Information
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NPI Number | 1487001616
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY CHOICE HOSPICE AND PALLIATIVE CARE, LLC
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 115 KNIGHT CIR
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City | CLEMSON
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State | SC
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Zip | 29631-2113
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Country | US
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Telephone | 864-653-5468
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Fax |
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Provider Business Mailing Address
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Address Line | 115 KNIGHT CIR
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City | CLEMSON
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State | SC
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Zip | 29631-2113
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Country | US
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Telephone | 864-653-5468
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/MANAGER
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Name | CONSTANCIO K NAKUMA
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Credential | PHD, MBA
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Telephone | 864-653-5468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 212431
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 212431
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License Number State | SC
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