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	376J00000X	Homemaker
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1396059481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDUS HEALTHCARE (SOUTH CAROLINA), INC.

Provider Business Mailing Address
First Line	:	801 WARRENVILLE RD STE 800
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-0912
Country	:	US
Telephone Number	:	630-296-3400
Fax Number	:	630-487-2713

Provider Business Practice Location Address
First Line	:	3294 ASHLEY PHOSPHATE RD STE 1C
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29418-8465
Country	:	US
Telephone Number	:	843-569-0033
Fax Number	:	855-766-1501

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

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	05/02/2025

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