MEDICARE: ENCHANTED CARE HOME CARE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1205786001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCHANTED CARE HOME CARE LLC

Provider Business Mailing Address
First Line	:	620 DILLON TRACE ST APT 14
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29153-7486
Country	:	US
Telephone Number	:	803-410-8531
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 RAST ST STE J
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-2579
Country	:	US
Telephone Number	:	803-410-8531
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEOSHA MONIQUE THOMPSON
Credential	:
Telephone Number	:	803-410-8531

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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Directions to “ENCHANTED CARE HOME CARE LLC ” Practice Location

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