Provider Demographics
NPI:1780259804
Name:SUPPORTIVE IN-HOME CARE LLC
Entity type:Organization
Organization Name:SUPPORTIVE IN-HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:469-600-4161
Mailing Address - Street 1:925 LAKE SIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1260
Mailing Address - Country:US
Mailing Address - Phone:469-600-4161
Mailing Address - Fax:
Practice Address - Street 1:925 LAKE SIERRA WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1260
Practice Address - Country:US
Practice Address - Phone:469-600-4161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health