Provider Demographics
NPI:1598793192
Name:CAPITAL CARE RESOURCES OF SOUTH CAROLINA, LLC
Entity Type:Organization
Organization Name:CAPITAL CARE RESOURCES OF SOUTH CAROLINA, LLC
Other - Org Name:CENTERWELL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-297-5711
Mailing Address - Street 1:6330 SPRINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 BRENDAN WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3562
Practice Address - Country:US
Practice Address - Phone:864-297-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC470172Medicaid
SC470172Medicaid
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