Provider Demographics
NPI:1275531758
Name:LUTHERAN HOMES OF SC, INC.
Entity Type:Organization
Organization Name:LUTHERAN HOMES OF SC, INC.
Other - Org Name:LUTHERAN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PARKE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-749-5116
Mailing Address - Street 1:300 MINISTRY DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2366
Mailing Address - Country:US
Mailing Address - Phone:803-749-5110
Mailing Address - Fax:803-749-5111
Practice Address - Street 1:102 FORTRESS DR
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036
Practice Address - Country:US
Practice Address - Phone:803-461-0456
Practice Address - Fax:803-461-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-041251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP477005Medicaid
SCHSP477005Medicaid