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General NPI Number Information
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NPI Number | 1598145989
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Entity Type | Organization
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Legal Business Name | JIREH HEALTHCARE
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 159 DANIELS LN
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-8252
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Country | US
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Telephone | 843-439-6227
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1646
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City | BENNETTSVILLE
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State | SC
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Zip | 29512-1646
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Country | US
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Telephone | 843-439-6227
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MITCHELL ANTONY POUNCY SR.
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Credential |
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Telephone | 843-439-6227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0000011421
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License Number State | SC
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