Provider Demographics
NPI:1003553835
Name:NEBO HANDS OF SERENITY LLC
Entity Type:Organization
Organization Name:NEBO HANDS OF SERENITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:NEBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-417-4920
Mailing Address - Street 1:110 S BLACKSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2556
Mailing Address - Country:US
Mailing Address - Phone:864-417-4920
Mailing Address - Fax:
Practice Address - Street 1:110 S BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2556
Practice Address - Country:US
Practice Address - Phone:864-417-4920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCW91583SC1Medicaid