Provider Demographics
NPI:1659734432
Name:EMPOWERED PERSONAL CARE HOME HEALTH ALLIANCE INC
Entity Type:Organization
Organization Name:EMPOWERED PERSONAL CARE HOME HEALTH ALLIANCE INC
Other - Org Name:NORTHWOODS SENIOR LIVING AND MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:BARRINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-774-5700
Mailing Address - Street 1:1267 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-2138
Mailing Address - Country:US
Mailing Address - Phone:803-774-5700
Mailing Address - Fax:803-774-5705
Practice Address - Street 1:1267 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-2138
Practice Address - Country:US
Practice Address - Phone:803-774-5700
Practice Address - Fax:803-774-5705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPOWERED PERSONAL CARE HOME HEALTH ALLIANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC1442385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRC1442Medicaid