NPIMap

Organization Active NPI

Providence Care LLC

  • Community Based Hospice Care Agency
  • Rock Hill, SC
National Provider Identifier
1891005104
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
PENDING Issued in SC
Legal business name
PROVIDENCE CARE LLC
Practice address
500 Lakeshore Pkwy
Rock Hill, SC 29730-4273
Phone
(803) 818-6900
Fax
(803) 818-6993
NPI assigned
Oct 20, 2010
Last updated
Feb 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

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

Authorized official

Name
Beth Taylor
Title
Billing Administrator
Phone
(803) 372-5884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X PENDING SC Primary

Addresses

Primary practice location

500 Lakeshore Pkwy
Rock Hill, SC 29730-4273

Mailing address

PO Box 10984
Rock Hill, SC 29731-0984
Phone (844) 628-2273

Other practice location 1

634 Fairview Rd
Simpsonville, SC 29680-6707
Phone (864) 757-9434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101122000138 SC Part A Provider - Hospice 5193911840 Practice locations: Greenwood, SC; Rock Hill, SC; Simpsonville, SC
O20111024000487 SC Part B Supplier - Clinic/Group Practice 5193911840 Receives reassigned benefits from 1 practitioner
Practice locations: Piedmont, SC; Rock Hill, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891005104. Details of each certification follow.

Hospice certification: CCN 421605

Legal name
PROVIDENCE CARE LLC
Doing business as
PROVIDENCE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 7, 2011
Last certification
Mar 3, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Oct 22, 2010 in SC
Enrollment address
500 Lakeshore Pkwy
Rock Hill, SC 29730-4273

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence Hospice LLCCCN 421605 · All quality measures
Ownership
For-Profit
Certified
Apr 7, 2011
Medicare certification status
ActiveFrom the Provider of Services file

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
42D2260248Providence Care Hospice500 Lakeshore Parkway, Rock Hill, SC 29730Certificate of waiverMay 16, 2028

National Provider Directory

National Provider Directory

Locations

202 Wall St
Piedmont, SC 29673
Phone (843) 851-3126

114 E Main St
Ste 201
Rock Hill, SC 29730
Phone (803) 327-7264

634 Fairview Rd
#A
Simpsonville, SC 29680
Phone (864) 881-8777

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Gothic Corporation Organization, Durham, NC Corporation, Investment firm 5% Or Greater Indirect Ownership Interest Dec 30, 2021 5.8%
Sip Care Services, LLC Organization, Rock Hill, SC Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Dec 30, 2021 99.5%
Johnnie Garmon Individual 5% Or Greater Indirect Ownership InterestChief Development Officer Dec 30, 2021 9.75%
Corporate Director Oct 20, 2010
W-2 Managing Employee Oct 20, 2010
Todd Squilanti Individual Corporate Officer Dec 30, 2021
Sip Care (Itc) Intermediate Holdings, LL Organization, Rock Hill, SC Created for acquisition, LLC, Holding company 5% Or Greater Indirect Ownership Interest Dec 30, 2021 99.5%
Melanie Coates Individual Corporate Director Jan 1, 2025
Romin Shah Individual 5% Or Greater Indirect Ownership InterestCmo Dec 30, 2021 9.75%
SFT Private Equity LLC (2016) Organization, Madison, WI LLC, Investment firm 5% Or Greater Indirect Ownership Interest Dec 30, 2021 7.73%
Intandem Capital Opportunities Fund, LP Organization, New York, NY Investment firm 5% Or Greater Indirect Ownership Interest Dec 30, 2021 34.93%
Gina Wallace Individual W-2 Managing EmployeeDirector of Finance Jan 4, 2015
Robin Walton Individual W-2 Managing EmployeeAd; Jan 1, 2025
Intandem Capital Partners Fund II, LP Organization, New York, NY Investment firm 5% Or Greater Indirect Ownership Interest Dec 30, 2021 34.93%
Sip Care (Itc) Holdings, LLC Organization, Rock Hill, SC Created for acquisition, LLC, Holding company 5% Or Greater Indirect Ownership Interest Dec 30, 2021 99.5%
Michelle Bailey Individual W-2 Managing EmployeeClinical Director Jan 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Craig Resources LLC

    dba Craig HomeCare

    • Home Health Agency
    • Wichita, KS
    • NPI 1689699837

    Gothic Corporation, Intandem Capital Opportunities Fund, LP, SFT Private Equity LLC (2016)

    CMS ownership
  • Pathways Hospice, LLC
    • Community Based Hospice Care Agency
    • Monroe, GA
    • NPI 1881364750

    Gothic Corporation, Intandem Capital Opportunities Fund, LP, Intandem Capital Partners Fund II, LP, SFT Private Equity LLC (2016), Sip Care (Itc) Holdings, LLC

    CMS ownership
  • Pediatric Home Respiratory Services LLC

    dba Pediatric Home Service

    • Nursing Care Agency
    • Roseville, MN
    • NPI 1285706911

    Gothic Corporation, Intandem Capital Opportunities Fund, LP, SFT Private Equity LLC (2016)

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

Affiliated clinicians 5

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

NPI Registry JSON

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770940800000",
    "number": "1891005104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10984",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297310984",
            "telephone_number": "844-628-2273",
            "fax_number": "803-372-5911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 LAKESHORE PKWY",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297304273",
            "telephone_number": "803-818-6900",
            "fax_number": "803-818-6993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "634 Fairview Rd",
            "address_purpose": "LOCATION",
            "city": "Simpsonville",
            "state": "SC",
            "postal_code": "296806707",
            "country_code": "US",
            "telephone_number": "864-757-9434",
            "fax_number": "864-757-9484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-20",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "BILLING ADMINISTRATOR",
        "authorized_official_telephone_number": "803-372-5884"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "SC",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

Verify at the official NPI Registry.