Basic Information
| Provider Information | |||||||||
| NPI: | 1184735706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABACARE HOME MEDICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2353 HWY 17 NORTH | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294666807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433752870 | ||||||||
| FaxNumber: | 8433882550 | ||||||||
| Practice Location | |||||||||
| Address1: | 2353 HWY 17 NORTH | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294666807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433752870 | ||||||||
| FaxNumber: | 8433882550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | DECLEMENTE | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8433752870 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 010730667 | SC | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | DME2513 | 05 | SC | MEDICAID |