Provider Demographics
NPI:1326779885
Name:DEDICATED SOUTH CAROLINA HOLDING, LLC
Entity Type:Organization
Organization Name:DEDICATED SOUTH CAROLINA HOLDING, LLC
Other - Org Name:DEDICATED SENIOR MEDICAL CENTER FAIRWOLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-618-7245
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:5900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6227
Practice Address - Country:US
Practice Address - Phone:803-888-5425
Practice Address - Fax:803-830-7157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEDICATED SOUTH CAROLINA HOLDING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site