Provider Demographics
NPI:1417129750
Name:LOWCOUNTY NURSING GROUP
Entity Type:Organization
Organization Name:LOWCOUNTY NURSING GROUP
Other - Org Name:INTERIM HEALTHCARE - REGIONAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTANZO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-569-5510
Mailing Address - Street 1:1064 GARDNER RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5768
Mailing Address - Country:US
Mailing Address - Phone:843-569-5510
Mailing Address - Fax:
Practice Address - Street 1:1064 GARDNER RD
Practice Address - Street 2:SUITE 116
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5768
Practice Address - Country:US
Practice Address - Phone:843-569-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGO55Medicaid