Provider Demographics
NPI:1629533245
Name:PASSION WITH PURPOSE HOME CARE, LLC
Entity Type:Organization
Organization Name:PASSION WITH PURPOSE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-257-4811
Mailing Address - Street 1:1714 EDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-9184
Mailing Address - Country:US
Mailing Address - Phone:803-292-3193
Mailing Address - Fax:
Practice Address - Street 1:1714 EDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-9184
Practice Address - Country:US
Practice Address - Phone:803-257-4811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1902360811Medicaid