Provider Demographics
NPI:1760627319
Name:DOMINION HEALTH CARE LLC
Entity Type:Organization
Organization Name:DOMINION HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-413-0182
Mailing Address - Street 1:510 HICKORY GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0810
Mailing Address - Country:US
Mailing Address - Phone:843-413-0182
Mailing Address - Fax:843-413-0186
Practice Address - Street 1:510 HICKORY GROVE CIR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-0810
Practice Address - Country:US
Practice Address - Phone:843-413-0182
Practice Address - Fax:843-413-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332100000X, 332B00000X
SC332B00000X, 332BC3200X, 332BD1200X, 332BN1400X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies