Provider Demographics
NPI:1720357312
Name:TOTAL CARE NURSING AGENCY
Entity Type:Organization
Organization Name:TOTAL CARE NURSING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MCDUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL SURGICAL TEC
Authorized Official - Phone:843-432-6409
Mailing Address - Street 1:103 SANBORN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3423
Mailing Address - Country:US
Mailing Address - Phone:843-432-6409
Mailing Address - Fax:
Practice Address - Street 1:103 SANBORN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3423
Practice Address - Country:US
Practice Address - Phone:843-432-6409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28282N00000X
3140N1450X
SC313140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========Medicaid
SC=========Medicaid