1306093497 NPI number — CAROLINA HOME CARE, LLC

Table of content: GRISELDA IVETTE MARTINEZ TEC (NPI 1689379935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306093497 NPI number — CAROLINA HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA HOME CARE, 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:
1306093497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2317 ANDERSON FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-9213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-395-2181
Provider Business Mailing Address Fax Number:
843-395-2182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2317 ANDERSON FARM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29501-9213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-395-2181
Provider Business Practice Location Address Fax Number:
843-395-2182
Provider Enumeration Date:
08/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUGGINS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
GENE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
843-395-2181

Provider Taxonomy Codes

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

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

  • Identifier: EX 0900 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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