Basic Information
| Provider Information | |||||||||
| NPI: | 1285759399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND HOSPICE SERVICES GREENVILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 SE MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296812695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649630045 | ||||||||
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| Practice Location | |||||||||
| Address1: | 421 SE MAIN STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296812695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649630045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | REYNOLDS | ||||||||
| AuthorizedOfficialFirstName: | PHYLLIS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8649630045 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | HPC-096 | SC | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | HSP067 | 05 | SC | MEDICAID |