NPIMap

Organization Active NPI

Grove Park Pharmacy Home Care, LLC

  • Home Health Agency
  • Orangeburg, SC
National Provider Identifier
1649834045
Registry record updated May 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GROVE PARK PHARMACY HOME CARE, LLC
Practice address
1353 Grove Park Dr
Orangeburg, SC 29115-2455
Phone
(803) 536-6644
Fax
(803) 937-1528
NPI assigned
May 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2019

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

Authorized official

Name
Mrs. Deborah B Hare, LMSW
Title
Executive Director
Phone
(803) 536-6644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1353 Grove Park Dr
Orangeburg, SC 29115-2455

Mailing address

PO Box 701
Orangeburg, SC 29116-0701
Phone (803) 536-6644

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191214000270 SC Part A Provider - Home Health Agency 9234562703 Practice locations: Orangeburg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649834045. Details of each certification follow.

Home health agency certification: CCN 427861

Legal name
GROVE PARK PHARMACY HOME CARE, LLC
Doing business as
GROVE PARK PHARMACY HOME CARE, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 2, 2021
Last certification
Dec 2, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
1353 Grove Park Dr
Orangeburg, SC 29115-2455

Care Compare: Home health agency

Medicare Care Compare
Listed as
Grove Park Pharmacy Home Care, LLCCCN 427861 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Dec 2, 2021
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2180193Grove Park Pharmacy Home Care1353 Grove Park NE, Orangeburg, SC 29115Certificate of waiverMar 9, 2028

National Provider Directory

National Provider Directory

Locations

1353 Grove Park Dr
Orangeburg, SC 29115
Phone (803) 536-6644

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Debbie Hare Individual W-2 Managing EmployeeExecutive Director May 31, 2019 100%
Charles Thompson Individual 5% Or Greater Direct Ownership InterestOwner May 31, 2019 100%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1556668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556668800000",
    "number": "1649834045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 701",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291160701",
            "telephone_number": "803-536-6644",
            "fax_number": "803-937-1528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1353 GROVE PARK DR",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291152455",
            "telephone_number": "803-536-6644",
            "fax_number": "803-937-1528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROVE PARK PHARMACY HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-01",
        "last_updated": "2019-05-01",
        "status": "A",
        "authorized_official_last_name": "HARE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "803-536-6644",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

Verify at the official NPI Registry.