Provider Demographics
NPI:1164784732
Name:TOTAL HOME HEALTH CARE OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:TOTAL HOME HEALTH CARE OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LBSW
Authorized Official - Phone:864-419-0167
Mailing Address - Street 1:1 CHICK SPRINGS ROAD
Mailing Address - Street 2:STE. 103A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4913
Mailing Address - Country:US
Mailing Address - Phone:864-631-1733
Mailing Address - Fax:864-451-7227
Practice Address - Street 1:1 CHICK SPRINGS ROAD
Practice Address - Street 2:STE. 103A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4913
Practice Address - Country:US
Practice Address - Phone:864-631-1733
Practice Address - Fax:864-451-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC000000000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health