Provider Demographics
NPI:1740803337
Name:MMM HEALTHCARE LLC
Entity Type:Organization
Organization Name:MMM HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TWITTY
Authorized Official - Suffix:
Authorized Official - Credentials:BUISNESS OWNER
Authorized Official - Phone:571-449-0606
Mailing Address - Street 1:3011 DREAM CATCHER CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7099
Mailing Address - Country:US
Mailing Address - Phone:803-285-2245
Mailing Address - Fax:
Practice Address - Street 1:392 LANCASTER BYP E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4759
Practice Address - Country:US
Practice Address - Phone:803-285-2245
Practice Address - Fax:803-285-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEN1890Medicaid