Provider Demographics
NPI:1265799639
Name:ENSURE HOME CARE OF SOUTH CAROLINA
Entity type:Organization
Organization Name:ENSURE HOME CARE OF SOUTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:VELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-258-6366
Mailing Address - Street 1:3437 PONDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-2111
Mailing Address - Country:US
Mailing Address - Phone:704-975-2484
Mailing Address - Fax:864-651-1142
Practice Address - Street 1:1565 EBENEZER RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2494
Practice Address - Country:US
Practice Address - Phone:803-230-3415
Practice Address - Fax:803-701-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251E00000X, 251J00000X, 372600000X, 385H00000X
NCHC4546251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1762Medicaid