Provider Demographics
NPI:1013636406
Name:STAT HOME CARE
Entity Type:Organization
Organization Name:STAT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-540-1039
Mailing Address - Street 1:201 CAROLINA POINT PKWY APT 332
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6564
Mailing Address - Country:US
Mailing Address - Phone:864-540-1039
Mailing Address - Fax:
Practice Address - Street 1:1314 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-1332
Practice Address - Country:US
Practice Address - Phone:864-540-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333300000XSuppliersEmergency Response System Companies