At Home Senior Care Hospice
Organization Active NPI Community Based Hospice Care Agency · Newberry, SC
NPI 1225630460 · NPPES record last updated Nov 12, 2020
Key facts
- NPI
- 1225630460
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- AT HOME SENIOR CARE HOSPICE
- Practice address
- 1700 Main St
Newberry, SC 29108-3548 - Phone
- (803) 920-4265
- NPI assigned
- Nov 12, 2020
- Organization subpart
- No
Authorized official
- Name
- Rubie Williams, RN
- Title
- Director/Ceo
- Phone
- (803) 920-4265
Practitioners 1
Affiliated clinicians 1
Medicare Care Compare: Hospice
- Listed as
- At Home Senior Care
- Certified
- Feb 1, 2024
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Hospice certification: CCN 421649
- Legal name
- AT HOME SENIOR CARE HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Feb 1, 2024
- Last certification
- Jan 17, 2024
- Organization structure
- LLC · Proprietary
- Enrollment address
- 1700 Main St
Newberry, SC 29108-3548
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Rubie Williams |
5% Or Greater Direct Ownership Interest | Jun 22, 2020 | 100% |
| Corporate Officer |
Jun 22, 2020 | 100% | |
| Corporate Director |
Jun 22, 2020 | 100% | |
| W-2 Managing Employee |
Jun 22, 2020 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201214002572 | SC | Part a Provider - Hospice | 0345652426 | Practice locations: Newberry, SC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
1700 Main St
Newberry, SC 29108-3548
Mailing address
1700 Main St
Newberry, SC 29108-3548
Phone (803) 920-4265
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Newberry | ||
| Other URL | Newberry | Health Information Exchange (HIE) |
Other providers in Newberry, SC
- Audrey S Alleyne
- Jennifer Frick Amick
- Alexandria Anderson
- Angel Care Home Care
- At Home Senior Care
- Ilya M Averbuch
- Erwin Renwick Baker
- Mary E Baker
- Kelly Bannister
- Mary Margaret Bates
All providers in Newberry, SC · Community Based Hospice Care Agency in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.