Provider Demographics
NPI:1760723332
Name:AHAVA HOSPICE OF FLORENCE, LLC
Entity Type:Organization
Organization Name:AHAVA HOSPICE OF FLORENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-794-3269
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-1014
Mailing Address - Country:US
Mailing Address - Phone:843-468-9700
Mailing Address - Fax:803-791-1634
Practice Address - Street 1:2405 2ND LOOP RD
Practice Address - Street 2:SUITE C
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-1602
Practice Address - Country:US
Practice Address - Phone:843-468-9700
Practice Address - Fax:803-791-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC 0168315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient