=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669846382
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPITAL CARE RESOURCES OF SOUTH CAROLINA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2015
-----------------------------------------------------
Last Update Date | 09/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1704 E GREENVILLE ST SUITE 2D
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29621-7914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-932-4970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6330 SPRINT PKWY STE 300
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66211-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED SIGNATORY
-----------------------------------------------------
Name | JOHN NICHOLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-332-8200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHA-0001
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------