Provider Demographics
NPI:1790449270
Name:BEVID SENIOR CARE LLC
Entity Type:Organization
Organization Name:BEVID SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-266-3176
Mailing Address - Street 1:746 OLD SPARTANBURG HWY
Mailing Address - Street 2:
Mailing Address - City:WELLFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29385-9668
Mailing Address - Country:US
Mailing Address - Phone:864-266-3176
Mailing Address - Fax:
Practice Address - Street 1:746 OLD SPARTANBURG HWY
Practice Address - Street 2:
Practice Address - City:WELLFORD
Practice Address - State:SC
Practice Address - Zip Code:29385-9668
Practice Address - Country:US
Practice Address - Phone:864-249-0577
Practice Address - Fax:864-249-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No332U00000XSuppliersHome Delivered MealsGroup - Multi-Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7Z1183Medicaid