Provider Demographics
NPI:1700018264
Name:MOMMA & POPPA COMPANION AGENCY
Entity Type:Organization
Organization Name:MOMMA & POPPA COMPANION AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:G
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-833-3473
Mailing Address - Street 1:719 SHEARWATER CT UNIT 202
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-9395
Mailing Address - Country:US
Mailing Address - Phone:843-833-3473
Mailing Address - Fax:
Practice Address - Street 1:10080 OCEAN HWY
Practice Address - Street 2:SUITE 10B
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-5898
Practice Address - Country:US
Practice Address - Phone:843-833-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherEIN