Provider Demographics
NPI:1114164605
Name:SANDPIPER HOME HEALTH
Entity Type:Organization
Organization Name:SANDPIPER HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-847-9014
Mailing Address - Street 1:1224 VILLAGE CREEK LN APT B1
Mailing Address - Street 2:SANDPIPER RETIRMENT COMMUNITY
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3159
Mailing Address - Country:US
Mailing Address - Phone:843-881-6447
Mailing Address - Fax:832-881-5647
Practice Address - Street 1:1224 VILLAGE CREEK LN APT B1
Practice Address - Street 2:SANDPIPER RETIRMENT COMMUNITY
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3159
Practice Address - Country:US
Practice Address - Phone:843-881-6447
Practice Address - Fax:832-881-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA-0193251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42-7118Medicare UPIN