Provider Demographics
NPI:1508227372
Name:SHC HOME HEALTH SERVICES-CHIPLEY, LLC
Entity Type:Organization
Organization Name:SHC HOME HEALTH SERVICES-CHIPLEY, LLC
Other - Org Name:COMMUNITY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7800
Mailing Address - Fax:502-804-3734
Practice Address - Street 1:831 KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-6917
Practice Address - Country:US
Practice Address - Phone:850-638-8500
Practice Address - Fax:850-638-3167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHC HOME HEALTH SERVICES OF FLORIDA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-08
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107401Medicare Oscar/Certification