Provider Demographics
NPI:1619731643
Name:TRUSTED ALLY HOME CARE - SOUTH CAROLINA LLC
Entity Type:Organization
Organization Name:TRUSTED ALLY HOME CARE - SOUTH CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ERICK
Authorized Official - Last Name:HENDRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:720-601-1712
Mailing Address - Street 1:5299 DTC BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3321
Mailing Address - Country:US
Mailing Address - Phone:720-601-1712
Mailing Address - Fax:
Practice Address - Street 1:900 TRAIL RIDGE RD # 122
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7765
Practice Address - Country:US
Practice Address - Phone:803-989-5539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUSTED ALLY HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health