Caresouth Carolina, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Cheraw, SC
NPI 1285677443 · NPPES record last updated Mar 11, 2024
Key facts
- NPI
- 1285677443
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CARESOUTH CAROLINA, INC
- Practice address
- 812 State Rd
Cheraw, SC 29520-7113 - Phone
- (843) 537-0961
- NPI assigned
- Jun 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Ann Lewis
- Title
- Ceo
- Phone
- (843) 857-0111
Other NPIs on the same Medicare enrollment 11
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 25
Practitioners 73
-
Jeffrey Michael Brock, M.D.
-
Cathy Montgomery, DNP, APRN, FNP-C
-
Jack Wilson Rhyne, LCSW, LISW
-
Heather Deanna Alexander, FNP-C
-
Jeri Lynn Andrews, APRN, FNP-BC
-
Leandria Nichelle Bivens, LISW-CP
-
Jocelyn Boyer, DEEDEE
-
Elizabeth Brown, LISW-CP
-
Bradley D Burgess, M.A..
-
Nicole Hardee Chapman, LISW-CP
-
Amy Jennifer Cook, LISW-CP
-
Angela Council, FNP
-
Cindy Crittendon, DO
-
Johnathan Charles Davis, D.C.
-
James Bernard Fleming, M.D.
-
Ludie Kathleen Floyd-Moore, LISW-CP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Federally qualified health center certification: CCN 421824
- Legal name
- CARESOUTH CAROLINA INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 5, 1978 in SC
- Enrollment address
- 812 State Rd
Cheraw, SC 29520-2648
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Mary J Garvin |
Corporate Officer |
Apr 7, 1978 | |
| Ennis R Bryant |
Corporate Officer |
Jan 1, 1992 | |
| Flossie W Bartell |
Corporate Officer |
Jun 26, 2003 | |
| Teresa Gainey |
Corporate Officer |
Dec 19, 2019 | |
| Ann Marie Lewis |
Corporate Officer |
Apr 5, 1978 | |
| W-2 Managing Employee | Apr 5, 1978 | ||
| Trudy Drawhorn |
Corporate Officer |
Jul 27, 2017 | |
| Earnestine S Powe |
Corporate Officer |
Jan 1, 1984 | |
| Patricia M Henegan |
Corporate Officer |
Jul 27, 2017 | |
| Dorothy S Joyner |
Corporate Officer |
Jan 1, 1996 | |
| Gene T Harper |
Other |
Oct 16, 2023 | |
| Bonnie M Seals |
Corporate Officer |
Jan 1, 1996 | |
| Mary D Legrant |
Corporate Officer |
Jan 1, 1996 | |
| Jay S Hodge |
Corporate Officer |
Jan 1, 1998 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040511000280 | SC | Part B Supplier - Clinic/Group Practice | 1052221314 |
Receives reassigned benefits from 95 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Society Hill, SC; MC Coll, SC; Latta, SC; Lake View, SC; Hartsville, SC; Dillon, SC; Chesterfield, SC; Cheraw, SC… |
| O20100526000204 | SC | Part a Provider - Federally Qualified Health Center (FQHC) | 1052221314 | Practice locations: Cheraw, SC |
National Provider Directory
- Tax ID family
- Caresouth Carolina Inc
Locations
715 S Doctors Dr
Ste A
Cheraw, SC 29520
Phone (843) 537-2707
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
812 State Rd
Cheraw, SC 29520-7113
Mailing address
PO Box 1090
Hartsville, SC 29551-1090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FQC013 | Medicaid | SC | |
| CBP012 | Medicaid | SC |
Other providers in Cheraw, SC
- Ben E Burnett
- William Rhett Butler
- Butterfly Services LLC
- Tara Rhea Campbell
- Caresouth Carolina Inc
- Caresouth Carolina, Inc.
- Caring All the Time
- Carolina Eye Associates Inc
- Deekshitha Chandrasekhar
- Cheraw Behavioral Health Inc
All providers in Cheraw, SC · Federally Qualified Health Center (FQHC) 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 Mar 11, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.