Provider Demographics
NPI:1891713723
Name:STATE OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:SC DHEC PEE DEE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/HOME HEALTH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:803-576-2916
Mailing Address - Street 1:1705 W EVANS ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3331
Mailing Address - Country:US
Mailing Address - Phone:843-661-4762
Mailing Address - Fax:843-661-4790
Practice Address - Street 1:1705 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3331
Practice Address - Country:US
Practice Address - Phone:843-661-4762
Practice Address - Fax:843-661-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-009251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC395450Medicaid
SC153550OtherUNISON HEALTH PLAN OF SC
SC20021671OtherSELECT HEALTH PROVIDER
SC395450Medicaid
SC20021671OtherSELECT HEALTH PROVIDER
427854Medicare Oscar/Certification