Provider Demographics
NPI:1902099161
Name:HEALTHCARE ETC, LLC
Entity Type:Organization
Organization Name:HEALTHCARE ETC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUIREWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-708-4750
Mailing Address - Street 1:7340 PARKLANE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7644
Mailing Address - Country:US
Mailing Address - Phone:803-708-4750
Mailing Address - Fax:803-753-0160
Practice Address - Street 1:7340 PARKLANE RD STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7644
Practice Address - Country:US
Practice Address - Phone:803-708-4750
Practice Address - Fax:803-753-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3207Medicaid
SCEN2052Medicaid
SCEN2052Medicaid