42D0877062 CLIA NUMBER - SOUTH CAROLINA IN-HOME PARTNER-I, LLC DBA PROVIDENCE HOME HEALTH

Laboratory Demographics

  • CLIA Code: 42D0877062
  • Facility Name: SOUTH CAROLINA IN-HOME PARTNER-I, LLC DBA PROVIDENCE HOME HEALTH
  • Facility Address: 140 STONERIDGE DR, SUITE 520
    COLUMBIA, SC
    ZIP 29210
  • Facility Phone: (803) 343-5100
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: WILLIAM ERVIN
  • NPI Number: 1972001956
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 42D0877062
LAB Type Home Health Agency
Facility Name SOUTH CAROLINA IN-HOME PARTNER-I, LLC DBA PROVIDENCE HOME HEALTH
Street 140 STONERIDGE DR, SUITE 520
City COLUMBIA
State SC
ZIP 29210
Phone 8033435100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2025
Certificate Expiration Date 9/27/2027
Facility Type Home Health Agency
Lab Director WILLIAM ERVIN

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This page was last updated on: 5/18/2026