Healthcare Provider Details

I. General information

NPI: 1548215635
Provider Name (Legal Business Name): IN HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 STONERIDGE DR
COLUMBIA SC
29210-8240
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN DEAN SHIPMAN
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-1119
  • Fax:
Mailing address:
  • Phone: 419-254-7841
  • Fax: 419-252-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License NumberHPF-006
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHPC-111
License Number StateSC

VIII. Authorized Official

Name: MR. BARRY A LAZARUS
Title or Position: VICE PRESIDENT - REIMBURSEMENTS
Credential:
Phone: 419-252-5541