MEDICARE: MAXMATH TUTORING ONLINE INC., SOUTH CAROLINA BRANCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	170516-1117560	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063932739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXMATH TUTORING ONLINE INC., SOUTH CAROLINA BRANCH

Provider Business Mailing Address
First Line	:	1413 HIGHWAY 17 S
Second Line	:
City	:	SURFSIDE BCH
State	:	SC
Zip	:	29575-6040
Country	:	US
Telephone Number	:	888-959-4159
Fax Number	:	888-959-4173

Provider Business Practice Location Address
First Line	:	1413 HIGHWAY 17 S
Second Line	:
City	:	SURFSIDE BCH
State	:	SC
Zip	:	29575-6040
Country	:	US
Telephone Number	:	888-959-4159
Fax Number	:	888-959-4173

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEAN MAXCENE DECARDE
Credential	:
Telephone Number	:	888-959-4159

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	07/21/2022

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