1700487253 NPI number — TRUE VINE HOME CARE AGENCY LLC

Table of content: (NPI 1700487253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700487253 NPI number — TRUE VINE HOME CARE AGENCY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUE VINE HOME CARE AGENCY 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:
1700487253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TRUE VINE HOME CARE LLC AGENCY
Provider Second Line Business Mailing Address:
113 SOUTH HIGH WAY 52 STE E
Provider Business Mailing Address City Name:
MONCHS CORNER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29461-3956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-461-0635
Provider Business Mailing Address Fax Number:
843-761-0636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 S HIGHWAY 52 STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONCKS CORNER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29461-3956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-761-0635
Provider Business Practice Location Address Fax Number:
843-761-0636
Provider Enumeration Date:
11/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
843-599-0504

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)





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