Provider Demographics
NPI:1720005788
Name:STATE OF SOUTH CAROLINA
Entity Type:Organization
Organization Name:STATE OF SOUTH CAROLINA
Other - Org Name:DIVISION OF HOME HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MN
Authorized Official - Phone:803-898-0560
Mailing Address - Street 1:PO BOX 101106
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29211-0106
Mailing Address - Country:US
Mailing Address - Phone:803-898-0760
Mailing Address - Fax:803-898-0350
Practice Address - Street 1:1751 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2606
Practice Address - Country:US
Practice Address - Phone:803-898-0760
Practice Address - Fax:803-898-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC427000Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER