MEDICARE: COMFORT STAY ASSISTANCE OF FLORENCE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1407023021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT STAY ASSISTANCE OF FLORENCE LLC

Provider Business Mailing Address
First Line	:	3602 SAVANNAH GOVE ROAD
Second Line	:
City	:	EFFINGHAM
State	:	SC
Zip	:	29541
Country	:	US
Telephone Number	:	843-610-6679
Fax Number	:	843-676-9482

Provider Business Practice Location Address
First Line	:	3602 SAVANNAH GOVE ROAD
Second Line	:
City	:	EFFINGHAM
State	:	SC
Zip	:	29541
Country	:	US
Telephone Number	:	843-610-6679
Fax Number	:	843-676-9482

Authorized Official
Title or Position	:	OWNER
Name	:	MARCIA UNITA MILES
Credential	:
Telephone Number	:	843-610-6679

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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