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General NPI Number Information
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NPI Number | 1790842987
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Entity Type | Organization
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Legal Business Name | VNA OF GREATER BAMBERG, INC.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 923 MIDWAY ST
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City | BAMBERG
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State | SC
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Zip | 29003-1957
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Country | US
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Telephone | 803-245-5611
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Fax | 803-245-3259
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Provider Business Mailing Address
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Address Line | 923 MIDWAY ST PO BOX 1048
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City | BAMBERG
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State | SC
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Zip | 29003-1957
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Country | US
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Telephone | 803-245-5611
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Fax | 803-245-3259
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Authorized Official
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Title or Position | CFO
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Name | MR. JAVY RUDOLPH GWALTNEY III
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Credential |
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Telephone | 803-245-5611
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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 | HHA-045
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License Number State | SC
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