Provider Demographics
NPI:1518277029
Name:ADDUS HEALTHCARE (SOUTH CAROLINA), INC.
Entity Type:Organization
Organization Name:ADDUS HEALTHCARE (SOUTH CAROLINA), INC.
Other - Org Name:CAREPRO HEALTH SERVICES
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:847-303-5300
Mailing Address - Street 1:2401 S PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7486
Mailing Address - Country:US
Mailing Address - Phone:847-303-5300
Mailing Address - Fax:847-303-5376
Practice Address - Street 1:1800 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2433
Practice Address - Country:US
Practice Address - Phone:803-758-4000
Practice Address - Fax:803-758-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-0152333300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEN1057Medicaid