MEDICARE: JR HOME HEALTH AGENCY, INC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1811296130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JR HOME HEALTH AGENCY, INC

Provider Business Mailing Address
First Line	:	17 TECHNOLOGY CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-9591
Country	:	US
Telephone Number	:	803-763-6926
Fax Number	:	803-763-2030

Provider Business Practice Location Address
First Line	:	17 TECHNOLOGY CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-9591
Country	:	US
Telephone Number	:	803-763-6926
Fax Number	:	803-763-2030

Authorized Official
Title or Position	:	CEO
Name	:	MR. JAMES T ROBERTSON
Credential	:
Telephone Number	:	803-763-6926

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	03/25/2011

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