MEDICARE: HOLY CITY HOME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1427816958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY CITY HOME CARE LLC

Provider Business Mailing Address
First Line	:	8462 RICE BASKET LN
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7470
Country	:	US
Telephone Number	:	843-799-3383
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 FABER PLACE DR STE 300
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8587
Country	:	US
Telephone Number	:	843-799-3383
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ALLANCIA SORHAINDO
Credential	:	BSN, RN
Telephone Number	:	843-799-3383

Provider Enumeration Date	:	03/11/2024
Last Update Date	:	03/11/2024

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