Provider Demographics
NPI:1689697070
Name:STATE OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:SC DHEC MIDLANDS 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 1:2111 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-1603
Mailing Address - Country:US
Mailing Address - Phone:803-276-5818
Mailing Address - Fax:803-276-0168
Practice Address - Street 1:2111 WILSON RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-1603
Practice Address - Country:US
Practice Address - Phone:803-276-5818
Practice Address - Fax:803-276-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA--040251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC191525Medicaid
SC153548OtherUNISON HEALTH PLAN OF SC
SC20021665OtherSELECT HEALTH PROVIDER
SC=========031OtherTRICARE PROVIDER NUMBER
SC20021665OtherSELECT HEALTH PROVIDER
SC191525Medicaid