Organization
UPSTATE LIVING WATER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ORVILLE KEITH HOGANCAMP (OWNER)
(864) 569-5977
Entity
Organization
Contact information
Practice address
102 PARKINS MILL RD, GREENVILLE, SC 29607-2932
(864) 569-5977
Mailing address
102 PARKINS MILL RD UNIT A, GREENVILLE, SC 29607-2932
(864) 569-5977
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IHCP-0754
—
SC
Enumeration date
08/03/2018
Last updated
05/17/2024
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