Provider Demographics
NPI:1326383621
Name:UPSTATE HOME HEALTH CARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:UPSTATE HOME HEALTH CARE SOLUTIONS LLC
Other - Org Name:UPSTATE HOME CARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:864-527-0455
Mailing Address - Street 1:113 W ANTRIM DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2505
Mailing Address - Country:US
Mailing Address - Phone:864-527-0455
Mailing Address - Fax:866-304-3596
Practice Address - Street 1:113 W ANTRIM DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2505
Practice Address - Country:US
Practice Address - Phone:864-527-0455
Practice Address - Fax:866-304-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1181Medicaid
SC1181Medicaid