Healthcare Provider Details

I. General information

NPI: 1831743285
Provider Name (Legal Business Name): ALBANY ALLEN CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N MAIN ST STE A
MAULDIN SC
29662-2344
US

IV. Provider business mailing address

505 N MAIN ST STE A
MAULDIN SC
29662-2344
US

V. Phone/Fax

Practice location:
  • Phone: 864-236-8007
  • Fax: 864-520-2082
Mailing address:
  • Phone: 864-236-8007
  • Fax: 864-520-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberIHCP-0971
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: