Provider Demographics
NPI:1942250642
Name:INTERIM HEALTH CARE HOSPICE LLC
Entity Type:Organization
Organization Name:INTERIM HEALTH CARE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:REILLY
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-627-1200
Mailing Address - Street 1:16 HYLAND RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5756
Mailing Address - Country:US
Mailing Address - Phone:864-627-1200
Mailing Address - Fax:864-627-7102
Practice Address - Street 1:16 HYLAND RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5756
Practice Address - Country:US
Practice Address - Phone:864-627-1200
Practice Address - Fax:864-627-7102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERIM HEALTHCARE OF GREENVILLE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207RH0002X
SCHPC-045251G00000X
SCHPC0213251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP033Medicaid
SC421533Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER