MEDICARE: NATHAN RHODES

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	IHCP-0789	SC
2	251E00000X	Home Health Agency	IHCP-0058	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IHCP-0058	OTHER	SC	IN HOME CARE AGENCY LICENSE
2	IHCP-0789	OTHER	SC	IN HOME CARE AGENCY LICENSE

General Provider Information

NPI Number	:	1790348068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN RHODES

Provider Business Mailing Address
First Line	:	3800 FOREST DR STE C201
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4149
Country	:	US
Telephone Number	:	803-315-5769
Fax Number	:	803-233-2774

Provider Business Practice Location Address
First Line	:	3800 FOREST DR STE C201
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4149
Country	:	US
Telephone Number	:	803-315-5769
Fax Number	:	803-233-2774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	04/22/2019

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Directions to “ NATHAN RHODES ” Practice Location

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