Provider Demographics
NPI:1760415400
Name:SEA ISLAND COMPREHENSIVE HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:SEA ISLAND COMPREHENSIVE HEALTH CARE CORPORATION
Other - Org Name:SEA ISLAND HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-559-4137
Mailing Address - Street 1:3627 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4825
Mailing Address - Country:US
Mailing Address - Phone:843-559-4137
Mailing Address - Fax:843-559-9925
Practice Address - Street 1:3627 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4825
Practice Address - Country:US
Practice Address - Phone:843-559-4137
Practice Address - Fax:843-559-9925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEA ISLAND COMPREHENSIVE HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-025251E00000X
SCEX0076253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0076Medicaid
SC134194Medicaid
SC427007Medicare Oscar/Certification