Provider Demographics
NPI:1255174611
Name:SCC HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:SCC HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COUSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-735-8758
Mailing Address - Street 1:425 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1155
Mailing Address - Country:US
Mailing Address - Phone:443-735-8758
Mailing Address - Fax:
Practice Address - Street 1:425 OXFORD ST
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1155
Practice Address - Country:US
Practice Address - Phone:443-735-8758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty