Provider Demographics
NPI:1285759399
Name:HEARTLAND HOSPICE SERVICES GREENVILLE
Entity type:Organization
Organization Name:HEARTLAND HOSPICE SERVICES GREENVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-963-0045
Mailing Address - Street 1:421 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2695
Mailing Address - Country:US
Mailing Address - Phone:864-963-0045
Mailing Address - Fax:
Practice Address - Street 1:421 SE MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2695
Practice Address - Country:US
Practice Address - Phone:864-963-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-096251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHSP067Medicaid
SC42-1558Medicare ID - Type Unspecified