Provider Demographics
NPI:1366812265
Name:SOUTH CAROLINA HOME SERVICES LLC
Entity type:Organization
Organization Name:SOUTH CAROLINA HOME SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-658-0555
Mailing Address - Street 1:1297 PROFESSIONAL DR STE 201-C3
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5713
Mailing Address - Country:US
Mailing Address - Phone:843-274-5799
Mailing Address - Fax:
Practice Address - Street 1:1297 PROFESSIONAL DR STE 201-C3
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5713
Practice Address - Country:US
Practice Address - Phone:843-274-5799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECIATED HOME SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care