Provider Demographics
NPI:1144364878
Name:ORANGEBURG PERSONAL CARE SERVICE LLC
Entity type:Organization
Organization Name:ORANGEBURG PERSONAL CARE SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-531-2966
Mailing Address - Street 1:128 BEEF JERKY DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116
Mailing Address - Country:US
Mailing Address - Phone:803-531-2966
Mailing Address - Fax:803-534-2448
Practice Address - Street 1:128 BEEF JERKY DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29116
Practice Address - Country:US
Practice Address - Phone:803-531-2966
Practice Address - Fax:803-534-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health