Provider Demographics
NPI:1962547406
Name:ADDUS HEALTHCARE (SOUTH CAROLINA), INC.
Entity type:Organization
Organization Name:ADDUS HEALTHCARE (SOUTH CAROLINA), INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP CGRO
Authorized Official - Prefix:
Authorized Official - First Name:DARBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-3443
Mailing Address - Street 1:801 WARRENVILLE RD STE 800
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-0912
Mailing Address - Country:US
Mailing Address - Phone:630-296-3400
Mailing Address - Fax:630-487-2713
Practice Address - Street 1:56 BOONE TRL
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3515
Practice Address - Country:US
Practice Address - Phone:336-667-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDUS HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0000D0272Medicaid