Dedicated South Carolina Holding, LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

DEDICATED SOUTH CAROLINA HOLDING, LLC

Practice address

2571 Forest Dr
Columbia, SC 29204-2029

Phone

(803) 610-4199

Fax

(803) 830-7157

NPI assigned

Mar 30, 2022

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

(305) 628-6117

Specialties & licenses 1

Addresses

Other names 1

• Dedicated Senior Medical Center Forest 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

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

  • Non-Pharmacy Dispensing Site
  • Columbia, SC
  • NPI 1326779885
  NPD tax ID

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648598400000",
    "number": "1326788134",
    "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": "2571 FOREST DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042029",
            "telephone_number": "803-610-4199",
            "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": "2022-03-30",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "305-628-6117"
    },
    "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 Forest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katherine Decho, RN BSN CWOCN
• Decker Dialysis LLC
• Eric Pearson Decker, DO
• Dedicated South Carolina Holding, LLC
• Dedicated South Carolina Holding, LLC
• Deewan Deewan, MD
• Allison Foster Defelice, PH.D.
• Carter John Degennaro, MD
• Anjolea Roseanna Degraaf
• Adena Deholczer

• 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 Mar 30, 2022; 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.