Provider Demographics
NPI:1164040788
Name:A VILLAGE HOME CARE LLC
Entity Type:Organization
Organization Name:A VILLAGE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-937-5841
Mailing Address - Street 1:1408 RUSSELL ST STE 15
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-6071
Mailing Address - Country:US
Mailing Address - Phone:804-937-5841
Mailing Address - Fax:803-937-6436
Practice Address - Street 1:1408 RUSSELL ST STE 15
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6071
Practice Address - Country:US
Practice Address - Phone:804-937-5841
Practice Address - Fax:803-937-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care