Provider Demographics
NPI:1124473228
Name:GRISWOLD HOME CARE
Entity type:Organization
Organization Name:GRISWOLD HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-375-3044
Mailing Address - Street 1:120 SPRINGHALL DR STE F
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5335
Mailing Address - Country:US
Mailing Address - Phone:843-375-3044
Mailing Address - Fax:888-569-3211
Practice Address - Street 1:120 SPRINGHALL DR STE F
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5335
Practice Address - Country:US
Practice Address - Phone:843-375-3044
Practice Address - Fax:888-569-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0263305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization