MEDICARE: STILL WATER HOSPICE, 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	315D00000X	Inpatient Hospice
2	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1306363643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILL WATER HOSPICE, LLC

Provider Business Mailing Address
First Line	:	531 S MAIN ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 S MAIN ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2500
Country	:	US
Telephone Number	:	864-747-5265
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOHN MARSHALL LOOPER
Credential	:
Telephone Number	:	864-634-4004

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	08/28/2017

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Directions to “STILL WATER HOSPICE, LLC ” Practice Location

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