Provider Demographics
NPI:1497700454
Name:MEDI HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:MEDI HOME HEALTH AGENCY, INC.
Other - Org Name:MEDI HOME HEALTH & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JEFFCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-957-0500
Mailing Address - Street 1:PO BOX 1928
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1928
Mailing Address - Country:US
Mailing Address - Phone:803-957-0500
Mailing Address - Fax:888-342-6190
Practice Address - Street 1:530 INDEPENDENCE PKWY
Practice Address - Street 2:STE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5203
Practice Address - Country:US
Practice Address - Phone:757-420-7192
Practice Address - Fax:757-420-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010238196Medicaid
VA010238196Medicaid