MEDICARE: JUDAH CARE PROVIDER 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1407788847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDAH CARE PROVIDER 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	:	839-250-7377
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ASHLAND PARK LN STE B-2
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5100
Country	:	US
Telephone Number	:	839-250-7377
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATEYA DAISY SMITH
Credential	:
Telephone Number	:	839-250-7377

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

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