Provider Demographics
NPI:1225508294
Name:NIKKIEDA CHANEL ENTERPRISES
Entity Type:Organization
Organization Name:NIKKIEDA CHANEL ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKKIEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-908-1878
Mailing Address - Street 1:160 COUNTRY HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-8479
Mailing Address - Country:US
Mailing Address - Phone:803-908-1878
Mailing Address - Fax:
Practice Address - Street 1:160 COUNTRY HAVEN RD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-8479
Practice Address - Country:US
Practice Address - Phone:803-908-1878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No251B00000XAgenciesCase Management