MEDICARE: JUDAH MED 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	251J00000X	Nursing Care Agency
2	253Z00000X	In Home Supportive Care Agency

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	:	1285566612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDAH MED CARE LLC

Provider Business Mailing Address
First Line	:	100 ASHLAND PARK LN STE B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5100
Country	:	US
Telephone Number	:	803-233-7554
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ASHLAND PARK LN STE B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5100
Country	:	US
Telephone Number	:	803-233-7554
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMIN
Name	:	LATEYA DAISY SMITH
Credential	:
Telephone Number	:	803-233-7554

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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