Provider Demographics
NPI:1356011837
Name:JOSEPH, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 ANDERSON RD S
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3392
Mailing Address - Country:US
Mailing Address - Phone:803-230-2415
Mailing Address - Fax:803-701-9131
Practice Address - Street 1:454 ANDERSON RD S
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3392
Practice Address - Country:US
Practice Address - Phone:803-230-2415
Practice Address - Fax:803-701-9131
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1558251E00000X, 251J00000X, 372600000X, 385H00000X
SCEY1059253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEY1059Medicaid
SCIHCP-1558Medicaid