1396058301 NPI number — ANGELS ARM HOME HEALTHCARE

Table of content: (NPI 1396058301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396058301 NPI number — ANGELS ARM HOME HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELS ARM HOME HEALTHCARE
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:
1396058301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 PATRIDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VARNVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-943-2188
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 PATRIDGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VARNVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-943-2188
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
DAISY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
803-943-2188

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 305R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347C00000X , 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)