Provider Demographics
NPI:1588682447
Name:STATE OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:SC DHEC LOWCOUNTRY HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/HOME HEALTH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:803-576-2916
Mailing Address - Street 1:219 S LEMACKS ST
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-4374
Mailing Address - Country:US
Mailing Address - Phone:843-525-5917
Mailing Address - Fax:843-521-7621
Practice Address - Street 1:219 S LEMACKS ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-4374
Practice Address - Country:US
Practice Address - Phone:843-525-5917
Practice Address - Fax:843-521-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC272837Medicaid
SC153552OtherUNISON HEALTH PLAN OF SC
SC20021667OtherSELECT HEALTH PROVIDER
SC272837Medicaid
SC=========093OtherTRICARE PROVIDER NUMBER
SC=========067OtherBCBS OF SC