Provider Demographics
NPI:1598145989
Name:JIREH HEALTHCARE
Entity Type:Organization
Organization Name:JIREH HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:ANTONY
Authorized Official - Last Name:POUNCY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:843-439-6227
Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-1646
Mailing Address - Country:US
Mailing Address - Phone:843-439-6227
Mailing Address - Fax:
Practice Address - Street 1:159 DANIELS LN
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-8252
Practice Address - Country:US
Practice Address - Phone:843-439-6227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0000011421251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health