Provider Demographics
NPI:1891756458
Name:PORTSBRIDGE SOUTH CAROLINA, INC
Entity Type:Organization
Organization Name:PORTSBRIDGE SOUTH CAROLINA, INC
Other - Org Name:PORTSBRIDGE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSFELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:678-284-5856
Mailing Address - Street 1:1800 PHOENIX BLVD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5593
Mailing Address - Country:US
Mailing Address - Phone:678-284-5850
Mailing Address - Fax:770-909-3406
Practice Address - Street 1:109 HOSPITAL DR W
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3405
Practice Address - Country:US
Practice Address - Phone:803-939-2788
Practice Address - Fax:803-939-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC077251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP055Medicaid
SC421548Medicare ID - Type Unspecified