Provider Demographics
NPI: | 1659604924 |
---|---|
Name: | CAMDEN HOMECARE, LLC |
Entity Type: | Organization |
Organization Name: | CAMDEN HOMECARE, LLC |
Other - Org Name: | ALABAMA HOMECARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | EXECUTIVE VICE PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | NICHOLAS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GACHASSIN |
Authorized Official - Suffix: | III |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 337-233-1307 |
Mailing Address - Street 1: | PO BOX 51266 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAFAYETTE |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70505-1266 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 337-233-1307 |
Mailing Address - Fax: | 337-233-5764 |
Practice Address - Street 1: | 15 CLAIBORNE ST STE C |
Practice Address - Street 2: | |
Practice Address - City: | CAMDEN |
Practice Address - State: | AL |
Practice Address - Zip Code: | 36726-1709 |
Practice Address - Country: | US |
Practice Address - Phone: | 334-682-9050 |
Practice Address - Fax: | 334-682-9601 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-09-17 |
Last Update Date: | 2020-11-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 120225 | Medicaid |