1760723332 NPI number — AHAVA HOSPICE OF FLORENCE, LLC

Table of content: (NPI 1760723332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760723332 NPI number — AHAVA HOSPICE OF FLORENCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHAVA HOSPICE OF FLORENCE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760723332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1014
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRMO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29063-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-468-9700
Provider Business Mailing Address Fax Number:
803-791-1634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2405 2ND LOOP RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29501-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-468-9700
Provider Business Practice Location Address Fax Number:
803-791-1634
Provider Enumeration Date:
03/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
803-794-3269

Provider Taxonomy Codes

  • Taxonomy code: 315D00000X , with the licence number:  HPC 0168 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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