MEDICARE: RESTORATIVE HEALTH SERVICES OF SC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1891198487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATIVE HEALTH SERVICES OF SC, LLC

Provider Business Mailing Address
First Line	:	2 OFFICE PARK CT
Second Line	:	SUITE 201C1
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5948
Country	:	US
Telephone Number	:	803-262-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 OFFICE PARK CT
Second Line	:	SUITE 201C1
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5948
Country	:	US
Telephone Number	:	803-262-7115
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS ROSEMARY THIMOLEON
Credential	:
Telephone Number	:	803-262-7115

Provider Enumeration Date	:	09/26/2014
Last Update Date	:	09/26/2014

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