1598717605 NPI number — TRADITIONAL HOME CARE INC.

Table of content: (NPI 1598717605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598717605 NPI number — TRADITIONAL HOME CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRADITIONAL HOME CARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY HOME HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598717605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1928
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29071-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-957-0500
Provider Business Mailing Address Fax Number:
888-342-6190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6555 NW 9TH AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33309-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-973-9400
Provider Business Practice Location Address Fax Number:
954-968-3672
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFCOAT
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
803-957-0500

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  202650961 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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