Provider Demographics
NPI:1154324838
Name:SPECIALTY HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:SPECIALTY HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CLAYCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:812-476-5404
Mailing Address - Street 1:331 KIMBER LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2830
Mailing Address - Country:US
Mailing Address - Phone:812-476-5404
Mailing Address - Fax:812-476-5766
Practice Address - Street 1:331 KIMBER LN
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2830
Practice Address - Country:US
Practice Address - Phone:812-476-5404
Practice Address - Fax:812-476-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN002416251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
157529Medicare ID - Type Unspecified