Provider Demographics
NPI:1205014644
Name:PIEDMONT HOSPICE, LLC
Entity Type:Organization
Organization Name:PIEDMONT HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-478-4171
Mailing Address - Street 1:501 DEANNA LN STE A
Mailing Address - Street 2:
Mailing Address - City:WANDO
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8528
Mailing Address - Country:US
Mailing Address - Phone:843-766-3331
Mailing Address - Fax:843-766-3338
Practice Address - Street 1:209 RIVERSIDE CT STE A
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5226
Practice Address - Country:US
Practice Address - Phone:864-721-2900
Practice Address - Fax:864-721-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-133251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP098Medicaid
SC421585Medicare Oscar/Certification