Provider Demographics
NPI:1942580089
Name:ST. CHRISTOPHERS HOME CARE AGENCY, LLC.
Entity Type:Organization
Organization Name:ST. CHRISTOPHERS HOME CARE AGENCY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-419-5581
Mailing Address - Street 1:9005 TWO NOTCH RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5850
Mailing Address - Country:US
Mailing Address - Phone:803-419-5581
Mailing Address - Fax:803-419-5534
Practice Address - Street 1:9005 TWO NOTCH RD
Practice Address - Street 2:SUITE 22
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5850
Practice Address - Country:US
Practice Address - Phone:803-419-5581
Practice Address - Fax:803-419-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care