=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952215477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIRVANA DREAMS HEALTHCARE AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2026
-----------------------------------------------------
Last Update Date | 10/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 LEE AVE
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29924-3441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-403-9048
-----------------------------------------------------
Fax | 803-902-6588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 112
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29924-0112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-403-9048
-----------------------------------------------------
Fax | 803-902-6588
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGING MEMBER
-----------------------------------------------------
Name | TELETHA LUSHAY RUTH
-----------------------------------------------------
Credential | DNP, CRNA, APRN
-----------------------------------------------------
Telephone | 803-403-9048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------