Healthcare Provider Details

I. General information

NPI: 1437447869
Provider Name (Legal Business Name): ULTRA HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CRANBROOK CT
GASTON SC
29053-8112
US

IV. Provider business mailing address

165 CRANBROOK CT
GASTON SC
29053-8112
US

V. Phone/Fax

Practice location:
  • Phone: 803-767-3834
  • Fax: 803-939-7140
Mailing address:
  • Phone: 803-767-3834
  • Fax: 803-939-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberP23769
License Number StateSC

VIII. Authorized Official

Name: MRS. ROBIN HEMINGAY
Title or Position: PRESIDENT
Credential:
Phone: 803-201-2264