| Organization Name: | PROVIDENCE CARE LLC |
| NPI Number: | 1891005104 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHNNIE B GARMON (CHEIF EXECUTIVE OFFICER) |
| Mailing Address: | 202 Wall St Piedmont |
| State: | SC US |
| Postal Code: | 296736754 |
| Phone Number: | 8642958714 |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2010 |
| NPI Last Update Date: | 02/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | PENDING |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |