=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003807959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESTER HMA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 MEDICAL PARK DR
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29706-9769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-581-9416
-----------------------------------------------------
Fax | 803-581-8915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 173 COLUMBIA ST
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29706-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-581-9416
-----------------------------------------------------
Fax | 803-581-8915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VP AND GENERAL COUNSEL
-----------------------------------------------------
Name | TIMOTHY PARRY
-----------------------------------------------------
Credential | ESQ
-----------------------------------------------------
Telephone | 239-598-3176
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHA-184
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------