Provider Demographics
NPI:1265110498
Name:COUNTRY BEST HOME CARE LLC
Entity type:Organization
Organization Name:COUNTRY BEST HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANAE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBLIN GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-220-7464
Mailing Address - Street 1:1613 E WADSWORTH AVE # 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19150-1024
Mailing Address - Country:US
Mailing Address - Phone:302-220-7464
Mailing Address - Fax:
Practice Address - Street 1:1613 E WADSWORTH AVE # 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-1024
Practice Address - Country:US
Practice Address - Phone:302-220-7464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health