Provider Demographics
NPI:1982673836
Name:COMPREHENSIVE CARE LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:BORUCKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-236-1511
Mailing Address - Street 1:PO BOX 2246
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-2246
Mailing Address - Country:US
Mailing Address - Phone:803-256-1511
Mailing Address - Fax:803-256-7333
Practice Address - Street 1:1911 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3535
Practice Address - Country:US
Practice Address - Phone:803-256-1511
Practice Address - Fax:803-256-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3521Medicaid
SC7375Medicare PIN