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General NPI Number Information
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NPI Number | 1669086112
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Entity Type | Individual
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Provider Name | DAHYOJENDAYI L FULLWOOD
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Gender | Female
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 3236 LANDMARK DR STE 121
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-8490
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Country | US
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Telephone | 866-491-1636
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Fax | 843-737-4896
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Provider Business Mailing Address
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Address Line | 7620 RIVERS AVE SUITE 370 PMB#155
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-5008
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Country | US
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Telephone | 866-491-1636
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Fax | 843-737-4896
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number | IHCP-1297
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | IHCP-1297
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | IHCP-1297
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | IHCP-1297
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | IHCP-1297
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License Number State | SC
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | IHCP-1297
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License Number State | SC
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