Provider Demographics
NPI:1679351621
Name:DEFINITE DELIVERY HOME CARE LLC
Entity Type:Organization
Organization Name:DEFINITE DELIVERY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-862-2475
Mailing Address - Street 1:PO BOX 1495
Mailing Address - Street 2:
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-1495
Mailing Address - Country:US
Mailing Address - Phone:803-943-8554
Mailing Address - Fax:803-893-0021
Practice Address - Street 1:109 MARTIN LUTHER KING JR BLVD SOUTH
Practice Address - Street 2:BUILDING A-2
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918
Practice Address - Country:US
Practice Address - Phone:803-943-8554
Practice Address - Fax:803-893-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)