Provider Demographics
NPI:1295384725
Name:SAMANTHA JEAN HOME CARE
Entity type:Organization
Organization Name:SAMANTHA JEAN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:HISLOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-967-2758
Mailing Address - Street 1:49 ATHOL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1310
Mailing Address - Country:US
Mailing Address - Phone:413-523-8111
Mailing Address - Fax:
Practice Address - Street 1:49 ATHOL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1310
Practice Address - Country:US
Practice Address - Phone:413-523-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty