Provider Demographics
NPI:1760849236
Name:HOME INSTEAD OF CHARLESTON, LLC
Entity Type:Organization
Organization Name:HOME INSTEAD OF CHARLESTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-357-9777
Mailing Address - Street 1:11943 GRANDHAVEN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7861
Mailing Address - Country:US
Mailing Address - Phone:843-357-9777
Mailing Address - Fax:
Practice Address - Street 1:11943 GRANDHAVEN DR
Practice Address - Street 2:SUITE B
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7861
Practice Address - Country:US
Practice Address - Phone:843-357-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care