Provider Demographics
NPI:1790721207
Name:HOME THERAPY INC
Entity Type:Organization
Organization Name:HOME THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DOZIER
Authorized Official - Last Name:SIDERS
Authorized Official - Suffix:
Authorized Official - Credentials:RCP CRT CFOM CCT
Authorized Official - Phone:843-464-9688
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:3391 HWY. 76 E.
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574
Mailing Address - Country:US
Mailing Address - Phone:843-464-9688
Mailing Address - Fax:843-464-9687
Practice Address - Street 1:3391 HWY. 76 E.
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574
Practice Address - Country:US
Practice Address - Phone:843-464-9688
Practice Address - Fax:843-464-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2236Medicaid
SC4662180001Medicare NSC