Provider Demographics
NPI:1487001616
Name:TRI-COUNTY CHOICE HOSPICE AND PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:TRI-COUNTY CHOICE HOSPICE AND PALLIATIVE CARE, LLC
Other - Org Name:TRI-COUNTY CHOICE HOSPICE, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCIO
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAKUMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA
Authorized Official - Phone:864-653-5468
Mailing Address - Street 1:115 KNIGHT CIR
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2113
Mailing Address - Country:US
Mailing Address - Phone:864-653-5468
Mailing Address - Fax:
Practice Address - Street 1:115 KNIGHT CIR
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2113
Practice Address - Country:US
Practice Address - Phone:864-653-5468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC212431251G00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care