1689941676 NPI number — HOME CARE MEDICAL AIDS INC OF NINETY SIX

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689941676 NPI number — HOME CARE MEDICAL AIDS INC OF NINETY SIX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME CARE MEDICAL AIDS INC OF NINETY SIX
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:
1689941676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 LITTLE MOUNTAIN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NINETY SIX
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-543-3300
Provider Business Mailing Address Fax Number:
864-543-3301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 LITTLE MTN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NINETY SIX
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-543-3300
Provider Business Practice Location Address Fax Number:
864-543-3301
Provider Enumeration Date:
11/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KELLEE
Authorized Official Middle Name:
SMITH
Authorized Official Title or Position:
CERTIFIED RESPIRATORY THERAPIST
Authorized Official Telephone Number:
864-543-3300

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  1045 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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