Provider Demographics
NPI:1134726482
Name:NANNA'S LOVING CARE HOMECARE & SENIOR SERVICES LLC
Entity type:Organization
Organization Name:NANNA'S LOVING CARE HOMECARE & SENIOR SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:LATINYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-795-2072
Mailing Address - Street 1:220 E CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4326
Mailing Address - Country:US
Mailing Address - Phone:803-306-5752
Mailing Address - Fax:803-617-7460
Practice Address - Street 1:220 E CALHOUN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4326
Practice Address - Country:US
Practice Address - Phone:803-306-5752
Practice Address - Fax:803-617-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1870Medicaid