Provider Demographics
NPI:1750532842
Name:CAROLINA HOSPICE, LLC
Entity type:Organization
Organization Name:CAROLINA HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/S
Authorized Official - Phone:803-316-9056
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-0344
Mailing Address - Country:US
Mailing Address - Phone:803-467-1263
Mailing Address - Fax:803-774-4378
Practice Address - Street 1:447 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4232
Practice Address - Country:US
Practice Address - Phone:803-236-0041
Practice Address - Fax:803-774-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-0144251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421607Medicare Oscar/Certification