MEDICARE: KERSHAW HOSPITAL LLC

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	HHA-0321	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	:	1093705121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERSHAW HOSPITAL LLC

Provider Business Mailing Address
First Line	:	1165 HIGHWAY 1 S
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-8966
Country	:	US
Telephone Number	:	803-425-1182
Fax Number	:	803-432-6351

Provider Business Practice Location Address
First Line	:	1165 HIGHWAY 1 S
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-8966
Country	:	US
Telephone Number	:	803-425-1182
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT VICE PRESIDENT, SECRETARY
Name	:	KATHY J. TEAGUE
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	03/12/2021

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Directions to “KERSHAW HOSPITAL LLC ” Practice Location

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