Basic Information
| Provider Information | |||||||||
| NPI: | 1285626952 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPICE OF CHARLESTON HOME HEALTH AGENCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3870 LEEDS AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294057493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435293100 | ||||||||
| FaxNumber: | 8435293112 | ||||||||
| Practice Location | |||||||||
| Address1: | 3870 LEEDS AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294057493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435293100 | ||||||||
| FaxNumber: | 8435293112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RINEHART | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | WISE | ||||||||
| AuthorizedOfficialTitleorPosition: | OUTCOMES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8435293100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HHA-051 | SC | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 470350 | 05 | SC | MEDICAID |