1124591862 NPI number — SHELIA'S HELPING HANDS LLC

Table of content: (NPI 1124591862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124591862 NPI number — SHELIA'S HELPING HANDS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELIA'S HELPING HANDS LLC
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:
Provider Other Organization Name Type Code:
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:
1124591862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2052 INDUSTRIAL BLVD
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:
29072-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-490-3076
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 EASTBOURNE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29223-6711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-587-1008
Provider Business Practice Location Address Fax Number:
803-788-4853
Provider Enumeration Date:
01/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GLENN
Authorized Official First Name:
SHELIA
Authorized Official Middle Name:
LORRAINE
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
803-587-1008

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2018-56047-54941 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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