Basic Information
Provider Information | |||||||||
NPI: | 1114925369 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HOSPICE OF CHARLESTON, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3870 LEEDS AVE | ||||||||
Address2: | SUITE 101 | ||||||||
City: | NORTH CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294057493 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8435293100 | ||||||||
FaxNumber: | 8432663489 | ||||||||
Practice Location | |||||||||
Address1: | 3870 LEEDS AVE | ||||||||
Address2: | SUITE 101 | ||||||||
City: | NORTH CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294057493 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8435293100 | ||||||||
FaxNumber: | 8432663489 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2005 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RINEHART | ||||||||
AuthorizedOfficialFirstName: | SHARON | ||||||||
AuthorizedOfficialMiddleName: | WISE | ||||||||
AuthorizedOfficialTitleorPosition: | OUTCOMES MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8435293100 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RN | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | HPC-007 | SC | Y |   | Agencies | Hospice Care, Community Based |   |
ID Information
ID | Type | State | Issuer | Description | HSP003 | 05 | SC |   | MEDICAID |