MEDICARE: ADDUS HEALTHCARE (SOUTH CAROLINA), INC.

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		OH
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1215327069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDUS HEALTHCARE (SOUTH CAROLINA), INC.

Provider Business Mailing Address
First Line	:	2300 WARRENVILLE RD STE 100
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1717
Country	:	US
Telephone Number	:	630-296-3530
Fax Number	:

Provider Business Practice Location Address
First Line	:	7332 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9168
Country	:	US
Telephone Number	:	513-712-5030
Fax Number	:	513-712-5035

Authorized Official
Title or Position	:	EVP, CHIEF STRATEGY OFFICER
Name	:	DARBY ANDERSON
Credential	:
Telephone Number	:	630-296-3443

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	03/23/2023

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