MEDICARE: CAMELLIA'S HOME CARE

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	:	1750058459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMELLIA'S HOME CARE

Provider Business Mailing Address
First Line	:	3656 S IRBY ST STE A
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-5225
Country	:	US
Telephone Number	:	843-779-6740
Fax Number	:

Provider Business Practice Location Address
First Line	:	3656 S IRBY ST STE A
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-5225
Country	:	US
Telephone Number	:	843-779-6740
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHIANDRA KEYATA DAVIS
Credential	:
Telephone Number	:	843-373-8284

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	08/30/2021

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Directions to “CAMELLIA'S HOME CARE ” Practice Location

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