Provider Demographics
NPI:1124012026
Name:HOME HEALTH OF SOUTH CAROLINA INC
Entity Type:Organization
Organization Name:HOME HEALTH OF SOUTH CAROLINA INC
Other - Org Name:HOME HEALTH OF SOUTH CAROLINA INC - MIDLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:CEO/COO
Authorized Official - Phone:843-679-7060
Mailing Address - Street 1:PO BOX 5599
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-5599
Mailing Address - Country:US
Mailing Address - Phone:843-679-7060
Mailing Address - Fax:843-679-7073
Practice Address - Street 1:193 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3655
Practice Address - Country:US
Practice Address - Phone:803-939-0266
Practice Address - Fax:843-939-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA151251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC473027Medicaid
SC473027Medicaid