Provider Demographics
NPI:1003227331
Name:WINYAH HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:WINYAH HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:843-979-7079
Mailing Address - Street 1:137 PROFESSIONAL LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8631
Mailing Address - Country:US
Mailing Address - Phone:843-979-7079
Mailing Address - Fax:843-979-7057
Practice Address - Street 1:172 MCSWAIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4804
Practice Address - Country:US
Practice Address - Phone:803-771-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-0220251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCHHA-0220OtherDHEC LICENSE