Provider Demographics
NPI:1073076576
Name:SAM'S HOME CARE, LLC
Entity Type:Organization
Organization Name:SAM'S HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-577-5431
Mailing Address - Street 1:57 ALTHEA DR
Mailing Address - Street 2:
Mailing Address - City:ROSMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28772-0017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 ALTHEA DR
Practice Address - Street 2:
Practice Address - City:ROSMAN
Practice Address - State:NC
Practice Address - Zip Code:28772-0017
Practice Address - Country:US
Practice Address - Phone:828-384-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care