Provider Demographics
NPI:1306165220
Name:AHAVA HOSPICE, INC.
Entity type:Organization
Organization Name:AHAVA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CFO
Authorized Official - Phone:803-794-3269
Mailing Address - Street 1:7505 IRMO DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212
Mailing Address - Country:US
Mailing Address - Phone:803-794-3269
Mailing Address - Fax:803-791-1634
Practice Address - Street 1:7505 IRMO DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8637
Practice Address - Country:US
Practice Address - Phone:803-794-3269
Practice Address - Fax:803-791-1634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHPC-0151OtherDHEC LICENSE NUMBER
SC42-1600Medicare UPIN