Provider Demographics
NPI:1780122028
Name:HOSPICONIC SOUTHEASTERN LLC
Entity type:Organization
Organization Name:HOSPICONIC SOUTHEASTERN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONORATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-552-2880
Mailing Address - Street 1:7275 CROSS COUNTY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-3318
Mailing Address - Country:US
Mailing Address - Phone:843-552-2880
Mailing Address - Fax:843-552-2882
Practice Address - Street 1:7275 CROSS COUNTY RD
Practice Address - Street 2:SUITE E
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-3318
Practice Address - Country:US
Practice Address - Phone:843-552-2880
Practice Address - Fax:843-552-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy