MEDICARE: RESPITE HOUSE 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	261QA0600X	Adult Day Care Clinic/Center	ADC010	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518927045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESPITE HOUSE INC

Provider Business Mailing Address
First Line	:	3600 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-7329
Country	:	US
Telephone Number	:	803-254-1248
Fax Number	:	803-748-8606

Provider Business Practice Location Address
First Line	:	3600 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-7329
Country	:	US
Telephone Number	:	803-254-1248
Fax Number	:	803-748-8606

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. SUSAN C WRIGLEY
Credential	:	RN
Telephone Number	:	803-254-1248

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/22/2020

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Directions to “RESPITE HOUSE INC ” Practice Location

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