Organization
EXCELLENT BLACK ROSE HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON BLACK (OWNER)
(843) 382-3136
Entity
Organization
Contact information
Practice address
7 WINCHESTER RD, KINGSTREE, SC 29556-5772
(843) 372-3136
Mailing address
7 WINCHESTER RD, KINGSTREE, SC 29556-5772
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
10/05/2023
Last updated
10/05/2023
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