Provider Demographics
NPI:1972796670
Name:TRI-CITY DIABETIC HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:TRI-CITY DIABETIC HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-266-0027
Mailing Address - Street 1:2178A SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5345
Mailing Address - Country:US
Mailing Address - Phone:843-266-0027
Mailing Address - Fax:843-266-0030
Practice Address - Street 1:2178A SAVANNAH HWY
Practice Address - Street 2:SUITE G
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5345
Practice Address - Country:US
Practice Address - Phone:843-266-0027
Practice Address - Fax:843-266-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-25
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies