1699006353 NPI number — MURRY'S COMMUNITY CARE HOME

Table of content: (NPI 1699006353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699006353 NPI number — MURRY'S COMMUNITY CARE HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MURRY'S COMMUNITY CARE HOME
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:
WHITAKER'S COMMUNITY CARE
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:
1699006353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79 SAL SUE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29203-3821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-786-8561
Provider Business Mailing Address Fax Number:
803-714-1987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 SAL SUE 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:
29203-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-786-8561
Provider Business Practice Location Address Fax Number:
803-714-1987
Provider Enumeration Date:
01/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
VALENCIA
Authorized Official Middle Name:
WHITAKER
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
803-786-8561

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  RC0210 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320800000X , with the licence number: RC0208 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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