Provider Demographics
NPI:1770018871
Name:POTTE'RS HOUSE IN HOME CARE
Entity Type:Organization
Organization Name:POTTE'RS HOUSE IN HOME CARE
Other - Org Name:POTTER'S HOUSE IN ME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELRENA
Authorized Official - Middle Name:DENSIE
Authorized Official - Last Name:MCINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-890-6114
Mailing Address - Street 1:331 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-5383
Mailing Address - Country:US
Mailing Address - Phone:704-890-6114
Mailing Address - Fax:
Practice Address - Street 1:331 E MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5384
Practice Address - Country:US
Practice Address - Phone:704-890-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0610253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care