=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033295852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AWESOME IN HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 BROAD RIVER RD SUITE 108
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-7047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-750-8687
-----------------------------------------------------
Fax | 803-750-8627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 BROAD RIVER RD SUITE 108
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29210-7047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-750-8687
-----------------------------------------------------
Fax | 803-750-8627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MISS JEANNETTE COOLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-750-8687
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 20063159830733
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------