Provider Demographics
NPI:1629356290
Name:COMFORT CARE PROVIDERS, LLC
Entity Type:Organization
Organization Name:COMFORT CARE PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAKENYA
Authorized Official - Middle Name:NATORI
Authorized Official - Last Name:GALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-421-6894
Mailing Address - Street 1:1200 WOODRUFF RD. BLD A-3
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5748
Mailing Address - Country:US
Mailing Address - Phone:864-421-6894
Mailing Address - Fax:864-751-1695
Practice Address - Street 1:1200 WOODRUFF RD. BLD A-3
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5748
Practice Address - Country:US
Practice Address - Phone:864-421-6894
Practice Address - Fax:864-751-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1045Medicaid