Provider Demographics
NPI:1730124363
Name:CONGAREE HOME MEDICAL, INC.
Entity Type:Organization
Organization Name:CONGAREE HOME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-939-0086
Mailing Address - Street 1:1307 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-4344
Mailing Address - Country:US
Mailing Address - Phone:803-939-0086
Mailing Address - Fax:803-939-0073
Practice Address - Street 1:1307 STATE ST
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-4344
Practice Address - Country:US
Practice Address - Phone:803-939-0086
Practice Address - Fax:803-939-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNONE REQUIRED IN SC332B00000X
SCNOT REQUIRED IN SC332BP3500X, 335E00000X
SC65004626332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME864Medicaid
SCDME864Medicaid