Provider Demographics
NPI:1710983242
Name:ISLAND HEALTH CARE, INC
Entity Type:Organization
Organization Name:ISLAND HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOLCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-629-2727
Mailing Address - Street 1:PO BOX 8011
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31412-8011
Mailing Address - Country:US
Mailing Address - Phone:912-629-2727
Mailing Address - Fax:912-234-1718
Practice Address - Street 1:300 NEW RIVER PKWY STE 7
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4575
Practice Address - Country:US
Practice Address - Phone:912-629-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA111251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC470519Medicaid
SC427051Medicare ID - Type Unspecified