Provider Demographics
NPI:1235377615
Name:CARIS HEALTHCARE LLC
Entity Type:Organization
Organization Name:CARIS HEALTHCARE LLC
Other - Org Name:CARIS HEALTHCARE, COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-694-4762
Mailing Address - Street 1:121 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 131
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 131
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8417
Practice Address - Country:US
Practice Address - Phone:803-794-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIS HEALTHCARE LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-23
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP096Medicaid