Provider Demographics
NPI:1336494798
Name:ADDUS HEALTHCARE (SOUTH CAROLINA), INC.
Entity Type:Organization
Organization Name:ADDUS HEALTHCARE (SOUTH CAROLINA), INC.
Other - Org Name:ADDUS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL CONTRACTS
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMARICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, MBA
Authorized Official - Phone:630-296-3400
Mailing Address - Street 1:2300 WARRENVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1765
Mailing Address - Country:US
Mailing Address - Phone:630-296-3400
Mailing Address - Fax:630-487-2713
Practice Address - Street 1:3300 HIGHLANDS PKWY SE
Practice Address - Street 2:SUITE 140
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5131
Practice Address - Country:US
Practice Address - Phone:678-287-7398
Practice Address - Fax:855-807-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-1056253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA044-R-1056OtherLICENSE NUMBER
GA000972419Medicaid