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General NPI Number Information
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NPI Number | 1871764902
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Entity Type | Organization
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Legal Business Name | SOUTHWEST HOME CARELLC.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 503 W MAIN ST
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City | APPALACHIA
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State | VA
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Zip | 24216-1723
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Country | US
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Telephone | 276-565-1703
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Fax |
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Provider Business Mailing Address
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Address Line | 503 WEST MAIN ST.
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City | APPALCHIA
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State | VA
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Zip | 24216
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Country | US
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Telephone | 276-565-1703
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATOR
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Name | MRS. AMANDA SUE GARRETT
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Credential | NONE
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Telephone | 276-565-1703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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