Provider Demographics
NPI:1437474251
Name:ABACARE HOME MEDICAL, LLC
Entity Type:Organization
Organization Name:ABACARE HOME MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-934-9212
Mailing Address - Street 1:2353 HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-6807
Mailing Address - Country:US
Mailing Address - Phone:843-375-2870
Mailing Address - Fax:843-388-2550
Practice Address - Street 1:8410 RIVERS AVE
Practice Address - Street 2:SUITE E
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9271
Practice Address - Country:US
Practice Address - Phone:843-797-5700
Practice Address - Fax:843-824-9005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSISTIVE TECHNOLOGY MEDICAL EQUIPMENT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-05
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLIC-1-10-40943332B00000X
SC010018802332B00000X
SC10793332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2513Medicaid
SC5196860002Medicare NSC