Provider Demographics
NPI:1720660905
Name:A SPECIAL PLACE HOME CARE LLC
Entity Type:Organization
Organization Name:A SPECIAL PLACE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-327-6775
Mailing Address - Street 1:3729 W WILSON ST STE 7
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-8563
Mailing Address - Country:US
Mailing Address - Phone:252-327-6775
Mailing Address - Fax:
Practice Address - Street 1:3729 W WILSON ST STE 7
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-8563
Practice Address - Country:US
Practice Address - Phone:252-327-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health