MEDICARE: PENCHANT COMPANION CARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174769780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENCHANT COMPANION CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	2639 BOILING SPRINGS RD
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-6011
Country	:	US
Telephone Number	:	864-599-9468
Fax Number	:	864-599-9676

Provider Business Practice Location Address
First Line	:	2639 BOILING SPRINGS RD
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-6011
Country	:	US
Telephone Number	:	864-599-9468
Fax Number	:	864-599-9676

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MONIQUE KINARD
Credential	:
Telephone Number	:	864-599-9468

Provider Enumeration Date	:	01/02/2009
Last Update Date	:	06/29/2009

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