Provider Demographics
NPI:1063173458
Name:COMPASSIONATE CARE OF HARTSVILLE
Entity type:Organization
Organization Name:COMPASSIONATE CARE OF HARTSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:843-951-9990
Mailing Address - Street 1:750 W CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4412
Mailing Address - Country:US
Mailing Address - Phone:843-951-9990
Mailing Address - Fax:843-951-9989
Practice Address - Street 1:750 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4412
Practice Address - Country:US
Practice Address - Phone:843-951-9990
Practice Address - Fax:843-951-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center