Dedicated South Carolina Holding, LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

DEDICATED SOUTH CAROLINA HOLDING, LLC

Doing business as

Dedicated Senior Medical Center Fairwold

Practice address

5900 N Main St
Columbia, SC 29203-6227

Phone

(803) 888-5425

Fax

(803) 830-7157

NPI assigned

Jun 23, 2022

Last updated

Feb 1, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

DEDICATED SOUTH CAROLINA HOLDING, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Chen

Title

Authorized Official

Phone

(786) 618-7245

Specialties & licenses 1

Addresses

Other names 1

• Dedicated Senior Medical Center Fairwold Doing business as

Tax ID family

Dedicated South Carolina Holding LLC3 organizations share this tax ID, including this one

Part of

Dedicated South Carolina Holding LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Dedicated South Carolina Holding, LLC

  dba Dedicated Senior Medical Center Forest TC

  • Non-Pharmacy Dispensing Site
  • Columbia, SC
  • NPI 1295469245
  NPD tax ID
• Dedicated South Carolina Holding, LLC

  dba Dedicated Senior Medical Center Forest

  • Non-Pharmacy Dispensing Site
  • Columbia, SC
  • NPI 1326788134
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1326779885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "305-628-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 N MAIN ST",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036227",
            "telephone_number": "803-888-5425",
            "fax_number": "803-830-7157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED SOUTH CAROLINA HOLDING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEDICATED SOUTH CAROLINA HOLDING, LLC",
        "enumeration_date": "2022-06-23",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "786-618-7245"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedicated Senior Medical Center Fairwold",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dedicated Senior Medical Center Fairwold",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christie Coggins Debruhl, PHARMD, CGP
• Katherine Decho, RN BSN CWOCN
• Decker Dialysis LLC (Capitol Centre Dialysis)
• Eric Pearson Decker, DO
• Dedicated South Carolina Holding, LLC (Dedicated Senior Medical Center Forest TC)
• Dedicated South Carolina Holding, LLC (Dedicated Senior Medical Center Forest)
• Deewan Deewan, MD
• Allison Foster Defelice, PH.D.
• Keondre Deflanders, MS, BCBA
• Carter John Degennaro, MD

• Non-Pharmacy Dispensing Site in Columbia, SC
• Providers in Columbia, SC by specialty
• Non-Pharmacy Dispensing Site in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.