Provider Demographics
NPI:1609314707
Name:DYNASTY HOME CARE
Entity Type:Organization
Organization Name:DYNASTY HOME CARE
Other - Org Name:DYNASTY HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEKISHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-363-3374
Mailing Address - Street 1:210 W STONE AVE
Mailing Address - Street 2:SUITE LR5
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5452
Mailing Address - Country:US
Mailing Address - Phone:864-248-6334
Mailing Address - Fax:
Practice Address - Street 1:210 W STONE AVE
Practice Address - Street 2:SUITE LR5
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5452
Practice Address - Country:US
Practice Address - Phone:864-248-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0666253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care