MEDICARE: RELIANCE TRUST 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	:	1790074359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANCE TRUST LLC

Provider Business Mailing Address
First Line	:	101 RIDGE SPRING DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-9078
Country	:	US
Telephone Number	:	803-767-0206
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 RIDGE SPRING DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-9078
Country	:	US
Telephone Number	:	803-767-0206
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TRACEY RENA FOXWORTH
Credential	:
Telephone Number	:	803-767-0206

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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