MEDICARE: AFFECTIONATELY DEVOTED HOME HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency
3	332U00000X	Home Delivered Meals
4	174200000X	Meals Provider

General Provider Information

NPI Number	:	1104773472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFECTIONATELY DEVOTED HOME HEALTH

Provider Business Mailing Address
First Line	:	2411 N OAK ST STE 205F
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3164
Country	:	US
Telephone Number	:	888-304-2344
Fax Number	:	888-304-2344

Provider Business Practice Location Address
First Line	:	2411 N OAK ST STE 205F
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-3164
Country	:	US
Telephone Number	:	888-304-2344
Fax Number	:	888-304-2344

Authorized Official
Title or Position	:	CEO
Name	:	SHANYEL GIBSON
Credential	:
Telephone Number	:	888-304-2344

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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