Provider Demographics
NPI:1528433521
Name:CAPITAL CARE RESOURCES OF SOUTH CAROLINA, LLC
Entity type:Organization
Organization Name:CAPITAL CARE RESOURCES OF SOUTH CAROLINA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-317-9686
Mailing Address - Street 1:6330 SPRINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 PAMPLICO HWY
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6199
Practice Address - Country:US
Practice Address - Phone:843-317-9686
Practice Address - Fax:843-667-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-0009251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
427854Medicare Oscar/Certification