Provider Demographics
NPI:1255791661
Name:STAY-N-HOME
Entity type:Organization
Organization Name:STAY-N-HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:LATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-680-5189
Mailing Address - Street 1:561 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1946
Mailing Address - Country:US
Mailing Address - Phone:864-680-5189
Mailing Address - Fax:
Practice Address - Street 1:561 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1946
Practice Address - Country:US
Practice Address - Phone:864-680-5189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC02081989Medicaid